Alignment guides, cut guides, systems and methods of use and assembly

ABSTRACT

Guides, systems, and methods for maintaining, correcting and/or fusing joint deformities are disclosed. The guide system including a cut guide, an alignment guide, and at least one directional wire. The cut guide including a base portion, an extension member extending away from a bottom surface of the base portion, and at least one arm extending away from an end of the base portion. The alignment guide, including a base portion, a first extension member extending away from a bottom surface of the base portion in a first direction, and a second extension member extending away from the bottom surface of the base portion in a second direction. Methods of using a guide system for maintaining, correcting and/or fusing joint deformities are also disclosed.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.16/516,857 filed on Jul. 19, 2019 and entitled Alignment Guides, CutGuides, Systems and Methods of Use and Assembly and which will issue asU.S. Pat. No. 10,856,886 on Dec. 8, 2020, which is a continuation ofPCT/US2018/064368 filed on Dec. 7, 2018 and entitled Alignment Guides,Cut Guides, Systems and Methods of Use and Assembly, which claimspriority benefit under 35 U.S.C. § 119(e) of U.S. provisionalapplication No. 62/595,155, filed Dec. 6, 2017 and entitled AlignmentGuides, Cut Guides, Systems and Methods of Use and Assembly, which areincorporated herein by reference in their entireties.

TECHNICAL FIELD

The present disclosure relates generally to general, podiatric, andorthopaedic surgery related to joint deformities. More specifically, butnot exclusively, the present disclosure relates to devices, systems, andmethods for maintaining, correcting and/or fusing joint deformities.

BACKGROUND OF THE INVENTION

The Lapidus procedure is commonly used to correct a hallux valgusdeformity, which is a lateral deviation of the great toe, withsubsequent hypermobility (or laxity). The Lapidus procedure is alsocommonly used to repair failed surgeries. Typically, a wedge of bone isremoved in a biplanar direction at the distal end of the cuneiform,which will provide correction of the deformity and typically results inshortening of the first ray. The result of this shortening is a shift inweight distribution to the second ray, which can result inmetatarsalgia. When the first ray is shortened, the function of thepatient's sesamoids may also be affected because of the change in weightdistribution on the sesamoids. Currently, to avoid shortening of thefirst ray when doing a Lapidus procedure, the accepted practice is forsurgeons to make a straight transverse cut on the metatarsal, then cutonly the cartilage or a minimal wedge resection of the cuneiform toobtain realignment of the transverse plane intermetatarsal angle asdetermined by the surgeon. If shortening beyond an acceptable amountoccurs, a bone graft can be used to restore first ray length. Bloodsupply complications and anatomical height and weight bearing throughthe joint are all concerns for post-operative healing from a Lapidusprocedure.

Accordingly, it is an object of the present invention to overcome one ormore of the above-described drawbacks and/or disadvantages of thecurrently used procedures. For example, in view of the deficiencies ofthe current implants and methods of performing the Lapidus procedure andfusion of the first tarso-metatarsal joint, and similar implants andsurgical methods for other areas of the body where multiple bonestructures exist including, but not limited to, the hand, wrist andspine, it would be desirable to develop devices, systems,instrumentation, and methods for maintaining, correcting and/or fusingjoint deformities to overcome the above-noted deficiencies of thecurrently available solutions for addressing joint deformities.

SUMMARY OF THE INVENTION

The present disclosure is directed toward devices, systems and methodsfor use in maintaining, correcting and/or fusing joint deformities.

In one aspect of the present disclosure provided herein, is a guidesystem. The guide system including a cut guide, an alignment guidecoupled to the cut guide, and a directional wire engaging a portion ofthe alignment guide.

In another aspect of the present disclosure provided herein, is a cutguide. The cut guide including a base portion, an extension memberextending away from a bottom surface of the base portion, and at leastone arm extending away from an end of the base portion.

In yet another aspect of the present disclosure provided herein, is analignment guide. The alignment guide, including a base portion, a firstextension member extending away from a bottom surface of the baseportion in a first direction, and a second extension member extendingaway from the bottom surface of the base portion in a second direction.

In a further aspect of the present disclosure provided herein, is amethod for using the guide system. The method includes obtaining a cutguide, in which the cut guide includes a base portion, an extensionmember extending away from a bottom surface of the base portion, and atleast one arm extending away from an end of the base portion. The methodalso includes inserting the extension member into a joint space andcoupling the alignment guide to the cut guide. The method furtherincludes inserting a directional wire into at least one opening in thealignment guide and inserting a k-wire into a dorsal hole in the cutguide and checking the orientation of the cut guide. In addition, themethod includes inserting at least two wires through the at least onearm of the cut guide and into at least one bone and removing thealignment guide and k-wire. Next, the method includes cutting a firstbone and a second bone using at least one slot of the cut guide andremoving at least one lateral wire from the at least one bone and thecut guide. Then, the method includes moving the first and second bonesto the desired correctional position.

These and other objects, features and advantages of this disclosure willbecome apparent from the following detailed description of the variousaspects of the disclosure taken in conjunction with the accompanyingdrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate embodiments of the disclosure andtogether with the detailed description herein, serve to explain theprinciples of the disclosure. It is emphasized that, in accordance withthe standard practice in the industry, various features are not drawn toscale. In fact, the dimensions of the various features may bearbitrarily increased or reduced for clarity of discussion. The drawingsare only for purposes of illustrating preferred embodiments and are notto be construed as limiting the disclosure.

FIG. 1 is a top perspective view of one embodiment of a cut guide, inaccordance with an aspect of the present disclosure;

FIG. 2 is a bottom perspective view of the cut guide of FIG. 1 , inaccordance with an aspect of the present disclosure;

FIG. 3 is a side view of the cut guide of FIG. 1 , in accordance with anaspect of the present disclosure;

FIG. 4 is another side view of the cut guide of FIG. 1 , in accordancewith an aspect of the present disclosure;

FIG. 5 is an end view of the cut guide of FIG. 1 , in accordance with anaspect of the present disclosure;

FIG. 6 is another end view of the cut guide of FIG. 1 , in accordancewith an aspect of the present disclosure;

FIG. 7 is a top view of the cut guide of FIG. 1 , in accordance with anaspect of the present disclosure;

FIG. 8 is a bottom view of the cut guide of FIG. 1 , in accordance withan aspect of the present disclosure;

FIG. 9 is a top perspective view of another cut guide, in accordancewith an aspect of the present disclosure;

FIG. 10 is a bottom perspective view of the cut guide of FIG. 9 , inaccordance with an aspect of the present disclosure;

FIG. 11 is a top perspective view of another cut guide, in accordancewith an aspect of the present disclosure;

FIG. 12 is a bottom perspective view of the cut guide of FIG. 11 , inaccordance with an aspect of the present disclosure;

FIG. 13 is a side view of the cut guide of FIG. 11 , in accordance withan aspect of the present disclosure;

FIG. 14 is another side view of the cut guide of FIG. 11 , in accordancewith an aspect of the present disclosure;

FIG. 15 is an end view of the cut guide of FIG. 11 , in accordance withan aspect of the present disclosure;

FIG. 16 is another end view of the cut guide of FIG. 11 , in accordancewith an aspect of the present disclosure;

FIG. 17 is a top view of the cut guide of FIG. 11 , in accordance withan aspect of the present disclosure;

FIG. 18 is a bottom view of the cut guide of FIG. 11 , in accordancewith an aspect of the present disclosure;

FIG. 19 is a top perspective view of another cut guide, in accordancewith an aspect of the present disclosure;

FIG. 20 is a bottom perspective view of the cut guide of FIG. 19 , inaccordance with an aspect of the present disclosure;

FIG. 21 is a side view of the cut guide of FIG. 19 , in accordance withan aspect of the present disclosure;

FIG. 22 is another side view of the cut guide of FIG. 19 , in accordancewith an aspect of the present disclosure;

FIG. 23 is an end view of the cut guide of FIG. 19 , in accordance withan aspect of the present disclosure;

FIG. 24 is another end view of the cut guide of FIG. 19 , in accordancewith an aspect of the present disclosure;

FIG. 25 is a top view of the cut guide of FIG. 19 , in accordance withan aspect of the present disclosure;

FIG. 26 is a bottom view of the cut guide of FIG. 19 , in accordancewith an aspect of the present disclosure;

FIG. 27 is a top perspective view of another cut guide, in accordancewith an aspect of the present disclosure;

FIG. 28 is a bottom perspective view of the cut guide of FIG. 27 , inaccordance with an aspect of the present disclosure;

FIG. 29 is a side view of the cut guide of FIG. 27 , in accordance withan aspect of the present disclosure;

FIG. 30 is another side view of the cut guide of FIG. 27 , in accordancewith an aspect of the present disclosure;

FIG. 31 is an end view of the cut guide of FIG. 27 , in accordance withan aspect of the present disclosure;

FIG. 32 is another end view of the cut guide of FIG. 27 , in accordancewith an aspect of the present disclosure;

FIG. 33 is a top view of the cut guide of FIG. 27 , in accordance withan aspect of the present disclosure;

FIG. 34 is a bottom view of the cut guide of FIG. 27 , in accordancewith an aspect of the present disclosure;

FIG. 35 is a top perspective view of another cut guide, in accordancewith an aspect of the present disclosure;

FIG. 36 is a bottom perspective view of the cut guide of FIG. 35 , inaccordance with an aspect of the present disclosure;

FIG. 37 is a top perspective view of another cut guide, in accordancewith an aspect of the present disclosure;

FIG. 38 is a bottom perspective view of the cut guide of FIG. 37 , inaccordance with an aspect of the present disclosure;

FIG. 39 is a side view of the cut guide of FIG. 37 , in accordance withan aspect of the present disclosure;

FIG. 40 is another side view of the cut guide of FIG. 37 , in accordancewith an aspect of the present disclosure;

FIG. 41 is a first end view of the cut guide of FIG. 37 , in accordancewith an aspect of the present disclosure;

FIG. 42 is a second end view of the cut guide of FIG. 37 , in accordancewith an aspect of the present disclosure;

FIG. 43 is a top view of the cut guide of FIG. 37 , in accordance withan aspect of the present disclosure;

FIG. 44 is a bottom view of the cut guide of FIG. 37 , in accordancewith an aspect of the present disclosure;

FIG. 45 is a first side, perspective view of a guide system including analignment guide and the cut guide of FIG. 1 , in accordance with anaspect of the present disclosure;

FIG. 46 is a first end, perspective view of the guide system of FIG. 45, in accordance with an aspect of the present disclosure;

FIG. 47 is a first side, perspective view of the alignment guide of FIG.45 , in accordance with an aspect of the present disclosure;

FIG. 48 is a second side, perspective view of the alignment guide ofFIG. 47 , in accordance with an aspect of the present disclosure;

FIG. 49 is a side view of the alignment guide of FIG. 47 , in accordancewith an aspect of the present disclosure;

FIG. 50 is an end view of the alignment guide of FIG. 47 , in accordancewith an aspect of the present disclosure;

FIG. 51 is a bottom perspective view of the alignment guide of FIG. 47 ,in accordance with an aspect of the present disclosure;

FIG. 52 is a top perspective view of the alignment guide of FIG. 47 , inaccordance with an aspect of the present disclosure;

FIG. 53 is a side perspective view of the cut guide of FIG. 1 insertedinto a foot, in accordance with an aspect of the present disclosure;

FIG. 54 is a bottom, side perspective view of the cut guide and foot ofFIG. 53 , in accordance with an aspect of the present disclosure;

FIG. 55 is a side perspective view of the foot and cut guide of FIG. 53with the alignment guide of FIG. 47 inserted into the cut guide and adirectional wire inserted into the alignment guide, in accordance withan aspect of the present disclosure;

FIG. 56 is a top perspective view of FIG. 55 , in accordance with anaspect of the present disclosure;

FIG. 57 is a bottom perspective view of FIGS. 55 and 56 with guide wiresinserted through the cut guide into the bones of the foot, in accordancewith an aspect of the present disclosure;

FIG. 58 is a side view of FIG. 57 , in accordance with an aspect of thepresent disclosure;

FIG. 59 is a top view of FIG. 57 , in accordance with an aspect of thepresent disclosure;

FIG. 60 is a side view of FIGS. 57-59 after removal of the directionalwire, the alignment guide, and the lateral guide wire, in accordancewith an aspect of the present disclosure;

FIG. 61 is a first end, perspective view of FIG. 60 , in accordance withan aspect of the present disclosure;

FIG. 62 is a perspective, side view of the foot, cut guide and guidewires of FIGS. 60 and 61 with a saw blade inserted into a first slot ofthe cut guide, in accordance with an aspect of the present disclosure;

FIG. 63 is a side, perspective view of the foot, cut guide, and guidewires of FIG. 62 with the saw blade inserted into a second slot of thecut guide, in accordance with an aspect of the present disclosure;

FIG. 64 is a partially exploded, side perspective view of the foot andtwo guide wires of FIG. 63 with a position rotation device beinginserted onto at least one of the guide wires, in accordance with anaspect of the present disclosure;

FIG. 65 is a front perspective view of the position rotation device, inaccordance with an aspect of the present disclosure;

FIG. 66 is a top perspective view of an embodiment of a cut guide systemincluding a transparent cut guide and insertion handle, in accordancewith an aspect of the present disclosure;

FIG. 67 is a side view of the cut guide system of FIG. 66 , inaccordance with an aspect of the present disclosure;

FIG. 68 is a top view of the cut guide system of FIG. 66 , in accordancewith an aspect of the present disclosure;

FIG. 69 is an exploded, first end perspective view of the cut guidesystem of FIG. 66 with a solid cut guide, in accordance with an aspectof the present disclosure;

FIG. 70 is an exploded, second end perspective view of the cut guidesystem of FIG. 69 , in accordance with an aspect of the presentdisclosure;

FIG. 71 is an exploded first end view of the cut guide system of FIG. 69, in accordance with an aspect of the present disclosure;

FIG. 72 is an exploded second end view of the cut guide system of FIG.69 , in accordance with an aspect of the present disclosure;

FIG. 73 is a side view of the insertion handle of FIG. 66 , inaccordance with an aspect of the present disclosure;

FIG. 74 is a top view of the insertion handle of FIG. 66 , in accordancewith an aspect of the present disclosure;

FIG. 75 is a top perspective view of an embodiment of a cut guide, inaccordance with an aspect of the present disclosure;

FIG. 76 is a bottom perspective view of the cut guide of FIG. 75 , inaccordance with an aspect of the present disclosure;

FIG. 77 is a side view of the cut guide of FIG. 75 , in accordance withan aspect of the present disclosure;

FIG. 78 is another side view of the cut guide of FIG. 75 , in accordancewith an aspect of the present disclosure;

FIG. 79 is an end view of the cut guide of FIG. 75 , in accordance withan aspect of the present disclosure;

FIG. 80 is another end view of the cut guide of FIG. 75 , in accordancewith an aspect of the present disclosure;

FIG. 81 is a top view of the cut guide of FIG. 75 , in accordance withan aspect of the present disclosure;

FIG. 82 is a bottom view of the cut guide of FIG. 75 , in accordancewith an aspect of the present disclosure;

FIG. 83 is a top perspective view of an embodiment of a cut guide, inaccordance with an aspect of the present disclosure;

FIG. 84 is a bottom perspective view of the cut guide of FIG. 83 , inaccordance with an aspect of the present disclosure;

FIG. 85 is a top perspective view of an embodiment of a cut guide, inaccordance with an aspect of the present disclosure;

FIG. 86 is a bottom perspective view of the cut guide of FIG. 85 , inaccordance with an aspect of the present disclosure;

FIG. 87 is a side view of the cut guide of FIG. 85 , in accordance withan aspect of the present disclosure;

FIG. 88 is another side view of the cut guide of FIG. 85 , in accordancewith an aspect of the present disclosure;

FIG. 89 is an end view of the cut guide of FIG. 85 , in accordance withan aspect of the present disclosure;

FIG. 90 is another end view of the cut guide of FIG. 85 , in accordancewith an aspect of the present disclosure;

FIG. 91 is a top view of the cut guide of FIG. 85 , in accordance withan aspect of the present disclosure;

FIG. 92 is a bottom view of the cut guide of FIG. 85 , in accordancewith an aspect of the present disclosure;

FIG. 93 is a top perspective view of an embodiment of a cut guide, inaccordance with an aspect of the present disclosure;

FIG. 94 is a bottom perspective view of the cut guide of FIG. 93 , inaccordance with an aspect of the present disclosure;

FIG. 95 is a top perspective view of an embodiment of a cut guide, inaccordance with an aspect of the present disclosure;

FIG. 96 is a bottom perspective view of the cut guide of FIG. 95 , inaccordance with an aspect of the present disclosure;

FIG. 97 is a side view of the cut guide of FIG. 95 , in accordance withan aspect of the present disclosure;

FIG. 98 is another side view of the cut guide of FIG. 95 , in accordancewith an aspect of the present disclosure;

FIG. 99 is an end view of the cut guide of FIG. 95 , in accordance withan aspect of the present disclosure;

FIG. 100 is another end view of the cut guide of FIG. 95 , in accordancewith an aspect of the present disclosure;

FIG. 101 is a top view of the cut guide of FIG. 95 , in accordance withan aspect of the present disclosure;

FIG. 102 is a bottom view of the cut guide of FIG. 95 , in accordancewith an aspect of the present disclosure;

FIG. 103 is a top perspective view of an embodiment of a cut guide, inaccordance with an aspect of the present disclosure;

FIG. 104 is a bottom perspective view of the cut guide of FIG. 103 , inaccordance with an aspect of the present disclosure;

FIG. 105 is a top perspective view of an embodiment of a cut guide, inaccordance with an aspect of the present disclosure;

FIG. 106 is a bottom perspective view of the cut guide of FIG. 105 , inaccordance with an aspect of the present disclosure;

FIG. 107 is a side view of the cut guide of FIG. 105 , in accordancewith an aspect of the present disclosure;

FIG. 108 is another side view of the cut guide of FIG. 105 , inaccordance with an aspect of the present disclosure;

FIG. 109 is an end view of the cut guide of FIG. 105 , in accordancewith an aspect of the present disclosure;

FIG. 110 is another end view of the cut guide of FIG. 105 , inaccordance with an aspect of the present disclosure;

FIG. 111 is a top view of the cut guide of FIG. 105 , in accordance withan aspect of the present disclosure;

FIG. 112 is a bottom view of the cut guide of FIG. 105 , in accordancewith an aspect of the present disclosure;

FIG. 113 is a top perspective view of an embodiment of a cut guide, inaccordance with an aspect of the present disclosure; and

FIG. 114 is a bottom perspective view of the cut guide of FIG. 113 , inaccordance with an aspect of the present disclosure.

DETAILED DESCRIPTION FOR CARRYING OUT THE INVENTION

Generally stated, disclosed herein are devices, systems, and methods formaintaining, correcting and/or fusing joint deformities. Further,methods for using the devices and systems for maintaining, correctingand/or fusing joint deformities are discussed.

In this detailed description and the following claims, the wordsproximal, distal, anterior or plantar, posterior or dorsal, medial,lateral, superior and inferior are defined by their standard usage forindicating a particular part or portion of a bone or implant accordingto the relative disposition of the natural bone or directional terms ofreference. For example, “proximal” means the portion of a device orimplant nearest the torso, while “distal” indicates the portion of thedevice or implant farthest from the torso. As for directional terms,“anterior” is a direction towards the front side of the body,“posterior” means a direction towards the back side of the body,“medial” means towards the midline of the body, “lateral” is a directiontowards the sides or away from the midline of the body, “superior” meansa direction above and “inferior” means a direction below another objector structure. Further, specifically in regards to the foot, the term“dorsal” refers to the top of the foot and the term “plantar” refers thebottom of the foot.

Similarly, positions or directions may be used herein with reference toanatomical structures or surfaces. For example, as the current devices,systems, instrumentation and methods are described herein with referenceto use with the bones of the foot, the bones of the foot, ankle andlower leg may be used to describe the surfaces, positions, directions ororientations of the devices, systems, instrumentation and methods.Further, the devices, systems, instrumentation and methods, and theaspects, components, features and the like thereof, disclosed herein aredescribed with respect to one side of the body for brevity purposes.However, as the human body is relatively symmetrical or mirrored about aline of symmetry (midline), it is hereby expressly contemplated that thedevices, systems, instrumentation and methods, and the aspects,components, features and the like thereof, described and/or illustratedherein may be changed, varied, modified, reconfigured or otherwisealtered for use or association with another side of the body for a sameor similar purpose without departing from the spirit and scope of thedisclosure. For example, the devices, systems, instrumentation andmethods, and the aspects, components, features and the like thereof,described herein with respect to the right foot may be mirrored so thatthey likewise function with the left foot. Further, the devices,systems, instrumentation and methods, and the aspects, components,features and the like thereof, disclosed herein are described withrespect to the foot for brevity purposes, but it should be understoodthat the devices, systems, instrumentation and methods may be used withother bones of the body having similar structures.

Referring to the drawings, wherein like reference numerals are used toindicate like or analogous components throughout the several views, andwith particular reference to FIGS. 1-8 , there is illustrated a cutguide 100. The cut guide 100 includes a top surface 102, a bottomsurface 104, a first or proximal end 106, a second or distal end 108, afirst or medial side 110, and a second or lateral side 112. The cutguide 100 also includes a base portion 114 and a paddle, fin orextension member 128 extending away from the bottom surface 104 of thebase portion 114. The cut guide 100 further includes a first or proximalarm 130 extending away from the base portion 114 on a first end 106 anda second or distal arm 140 extending away from the base portion 114 on asecond end 108. The cut guide 100 may be, for example, a right foot cutguide.

As shown in FIGS. 1, 5 and 6 , the top surface 102 of the base portion114 may be, for example, curved or arced between the first side 110 andthe second side 112. In one embodiment, the top surface 102 of the baseportion 114 may include, for example, a flat or planar portionpositioned between a first curvature or arc extending from the firstside 110 to the flat portion and a second curvature or arc extendingfrom a second side 112 to the flat portion. The base portion 114 alsoincludes at least one slot 116, 118, 120, 122, as shown in FIGS. 1-4, 7and 8 . In the depicted embodiment, the base portion 114 includes afirst slot 116 adjacent to a second slot 118 and a third slot 120adjacent to a fourth slot 122. The first and second slots 116, 118 maybe, for example, positioned on the second end 108 of the base portion114 and the third and fourth slots 120, 122 may be, for example,positioned on the first end 106 of the base portion 114.

With continued reference to FIGS. 1-4 and 7 , the slots 116, 118, 120,122 may extend, for example, linearly through the base portion 114 fromthe top surface 102 to the bottom surface 104 of the cut guide 100.Alternatively, the slots 116, 118, 120, 122 may also be, for example,angled as the slots 116, 118, 120, 122 extend from the top surface 102to the bottom surface 104. The slots 116, 118, 120, 122 may be angled,for example, approximately 1° to 4° and more specifically, approximately2°, as they extend between the top surface 102 and the bottom surface104. It is also contemplated that some of slots 116, 118, 120, 122 maybe angled and other slots 116, 118, 120, 122 may be linear as theyextend through the base portion 114 from the top surface 102 to thebottom surface 104.

In addition, the slots 116, 118, 120, 122 may be angled as they extendbetween the first side 110 and the second side 112, for example, theslots may be angled approximately 0° to 30° as the slots 116, 118, 120,122 extend between the first and second sides 110, 112. As shown, slots116, 118, 120, 122 have an angle of 0° as the slots 116, 118, 120, 122extend between the first and second sides 110, 112. Although not shownwith respect to cut guide 100, it is also contemplated that a first setof slots 116, 118 may be angled as they extend between the first andsecond sides 110, 112 and the second set of slots 120, 122 may bestraight, and vice versa. As shown, the slots 120, 122 are positioned toextend between the first and second sides 110, 112 parallel to the firstmetatarsal, as discussed in greater detail below with respect to themethod of using the cut guide 100. The slots 116, 118, 120, 122 may beconfigured or sized and shaped to receive a saw blade and may have awidth of, for example, approximately 0.58 mm to 0.92 mm. The slots 116,118, 120, 122 may be positioned, for example, to allow for removal ofthe articular cartilage layer of the two bones. To prevent resectingmore bone than absolutely necessary, the slots 116, 118, 120, 122 may bepositioned, for example, such that the medial portion of the slots 116,118, 120, 122 are aligned with the intersection of the cartilage andbone. In one embodiment, the slots 116, 118 are positioned a firstdistance from the extension member 128, the slots 120, 122 arepositioned a second distance from the extension member 128, and thefirst distance is smaller than the second distance. The first distancemay be measured from the extension member 128 to an inner surface of theslots 116, 118 and the second distance may be measured from theextension member 128 to an inner surface of the slots 120, 122.

The base portion 114 may also include a hole or dorsal hole 124, asshown in at least FIGS. 4, 7 and 8 . The hole 124 is positioned betweenthe second slot 118 and the third slot 120 near the second side 112 ofthe base portion 114. The hole 124 may extend, for example, into thebase portion 114 from the top surface 102 of the cut guide 100 and to apoint within the extension member 128. As shown in FIGS. 2 and 8 , asthe hole 124 extends into the extension member 128, the hole 124 forms athrough hole in a proximal-distal direction through the extension member128. The hole 124 may, for example, extend into the cut guide 100parallel to the angled portion of the extension member 128, as shown inFIG. 2 . The hole 124 may be sized and shaped or configured, forexample, to receive a wire, alignment wire, k-wire, guide wire or thelike to provide information on the position of the cut guide 100 in ajoint. For example, the wire inserted into hole 124 should alignapproximately with the long axis of the tibia to provide the properorientation of the cut guide 100 in the joint, which may be, forexample, approximately 45° from dorsal and 45° from medial.

Referring now to FIGS. 1-4 and 8 , the base portion 114 also includes arecessed region 126 positioned on the bottom surface 104. The recessedregion 126 extends from the first side 110 to the second side 112 andinto the base portion 114 a first distance from the bottom surface 104toward the top surface 102. The extension member 128 is coupled to therecessed region 126 of the base portion 114 and extends away from therecessed region 126 of the base portion 114. In addition, the extensionmember 128 is positioned between the second slot 118 and the third slot120 and also extends from the second side 112 toward the first side 110,as shown in FIGS. 5, 6 and 8 . The extension member 128 may be shaped,for example, to fit within the joint space between two bones, such as, afirst metatarsal and cuneiform, as well as to make contact with theadjoining articular joint surfaces. The extension member 128 may includea perpendicular portion near the first side 110 that extendsperpendicularly away from the bottom surface 104. The perpendicularportion of the extension member 128 may be, for example, angled when thecut guide 100 is inserted into a patient's joint and the angle that theperpendicular portion is positioned at may correspond to the angle ofthe first tarso-metatarsal joint medially. The extension member 128 mayalso include an angled portion extending from the second side 112 to theend of the extension member 128. The angled portion of the extensionmember 128 may, for example, allow for the extension member 128 to fitwithin a variety of anatomic presentations. The angled portion of theextension member 128 may, for example, be oriented laterally and shouldalign with the long axis of the tibia, as well as fit within the jointto rest against the relatively straight surface of the adjacent bone,for example, the second metatarsal. When the angled portion of theextension member 128 is oriented against the second metatarsal, the cutguide 100 will be positioned at a 45° angle in the frontal plane.

As shown in FIGS. 1, 2, 7 and 8 , the first or proximal arm 130 mayextend away from an end of the base portion 114 and may be, for example,tapered from the base portion 114 to the first end 106 of the cut guide100. The first arm 130 includes at least one opening 132, 134. In thedepicted embodiment, the first arm 130 includes a first opening 132 anda second opening 134 positioned near the first end 106. The firstopening 132 may be spaced apart from the second opening 134. Theopenings 132, 134 may extend from a top surface 102 to a bottom surface104 of the cut guide 100. The openings 132, 134 may extend through thefirst arm 130, for example, parallel to the extension member 128, angledas they extend from the top surface 102 toward the bottom surface 104,or a combination of parallel and angled. In one embodiment, the firstopening 132 may extend, for example, parallel to the extension member128 and the second opening 134 may be, for example, angled with respectto the extension member 128 to permit the inserted wires, guide wires,k-wires and the like to cross above the cut guide 100 withoutintersecting. By positioning the openings 132, 134 such that insertedwires cross above the openings 132, 134 allows for a smaller surgicalincision and less interaction or interference with other instrumentsduring the procedure. The openings 132, 134 positioning the wires tocross also allows for the cut guide 100 to be, for example, suspendedabove and/or proximate to the bone surfaces being cut. The ability tosuspend the cut guide 100 above the bone surfaces prevents the cut guide100 from being titled because of varying patient anatomy and this avoidsmoving the slots 116, 118, 120, 122 which would affect the proposed cutangles. Alternative combinations of orientations of the openings 132,134 are also contemplated, as would be understood by one of ordinaryskill in the art from the above description. The first arm 130 may beshaped to provide a bone contacting surface 136 that corresponds to theshape of the bone that it will engage. The first arm 130 may be, forexample, curved or arced as it extends between the first side 110 andthe second side 112.

As shown in FIGS. 1, 2, 7 and 8 , the second or distal arm 140 mayextend away from an end of the base portion 114 and may be, for example,tapered from the base portion 114 to the second end 108 of the cut guide100. The second arm 140 includes at least one opening 142, 144. In thedepicted embodiment, the second arm 140 includes a third opening 142 anda fourth opening 144 positioned near the second end 108. The thirdopening 142 may be spaced apart from the fourth opening 144 and extendfrom a top surface 102 to a bottom surface 104 of the cut guide 100. Theopenings 142, 144 may extend through the second arm 140, for example,parallel to the extension member 128, angled as they extend from the topsurface 102 toward the bottom surface 104, or a combination of paralleland angled. In one embodiment, the third opening 142 may extend, forexample, parallel to the extension member 128 and the fourth opening 144may be, for example, angled with respect to the extension member 128 topermit inserted wires, guide wires, k-wires, and the like to cross abovethe cut guide 100 without intersecting. By positioning the openings 142,144 such that the inserted wires cross above the openings 142, 144allows for a smaller surgical incision and less interaction orinterference with other instruments during the procedure. The openings142, 144 being positioned for the wires to cross, also allows for thecut guide 100 to be, for example, suspended above and/or mated with thebone surfaces being cut. Suspending the cut guide 100 above the bonesurfaces prevents the cut guide 100 from being angled because of varyingpatient anatomy which results in not having to move the slots 116, 118,120, 122 which would affect the proposed cut angles. In one embodiment,the openings 132, 142 may be, for example, positioned such that they areparallel to one another as they extend between the top and bottomsurfaces 102, 104. By positioning the openings 132, 142 parallel to eachother, the cut guide 100 may be, for example, removed from guide wiresinserted through openings 132, 142 without removing the guide wires. Inaddition, parallel openings 132, 142 allow for the relative rotationbetween the two guide wires to be measured or calculated after the bonesare cut using cut guide 100. Further, the openings 132, 142 may be, forexample, spaced apart from the extension member 128 a standard or setdistance to allow for interchangeability with alternative cut guides200, 250, 300, 400, if a different or additional resection is needed.Alternative, combinations of orientations of the openings 142, 144 arealso contemplated, as would be understood by one of ordinary skill inthe art from the above description. The second arm 140 may be shaped toprovide a bone contacting surface 146 that corresponds to the shape ofthe bone that it will engage. The second arm 140 may be, for example,curved or arced as it extends between the first side 110 and the secondside 112. The second arm 140 may have, for example, a larger length andwidth than the first arm 130.

Referring now to FIGS. 9 and 10 , another cut guide 150 is shown. Thecut guide 150 is a mirror image of the cut guide 100 in a medial-lateraldirection, which will not be described again in full detail for brevitypurposes. For example, the hole 124 is positioned on a left side of thecut guide 100 when in an insertion position and the hole 174 ispositioned on a right side of the cut guide 150 when in an insertionposition. The cut guide 150 may be, for example, for a left foot. Thecut guide 150 may include a top surface 152, a bottom surface 154, afirst or proximal end 156, a second or distal end 158, a first or medialside 160, and a second or lateral side 162, which may be of the typedescribed above with respect to the top surface 102, the bottom surface104, the first or proximal end 106, the second or distal end 108, thefirst or medial side 110, and the second or lateral side 112,respectively. The cut guide 150 may also include a base portion 164which may be the mirror image of the base portion 114, as describedabove. The slots 166, 168, 170, 172, the hole 174, and the recessedregion 176 may be similar to the slots 116, 118, 120, 122, hole 124, andrecessed region 126, as described in greater detail above. Further, thecut guide 150 may include a fin, paddle or extension member 178, a firstor proximal arm 180, and a second or distal arm 190, which may be asdescribed above with respect to the extension member 128, the first arm130, and the second arm 140, respectively. The openings 182, 184 and thebone contacting surface 186 may be as described above with reference toopenings 132, 134 and bone contacting surface 136 and the openings 192,194 and the bone contacting surface 196 may be as described above withreference to openings 142, 144 and the bone contacting surface 146,which will not be described again here for brevity purposes.

Another cut guide 200 is shown in FIGS. 11-18 . The cut guide 200includes a top surface 202, a bottom surface 204, a first or proximalend 206, a second or distal end 208, a first or medial side 210, and asecond or lateral side 212. The top surface 202 may be, for example,wider than the top surface 102 of cut guide 100 providing for largerangular corrections. The cut guide 200 also includes a base portion 214,a paddle, fin or extension member 228 extending away from the bottomsurface 204 of the base portion 214, a first or proximal arm 230extending away from the base portion 214 on the first end 206, and asecond or distal arm 240 extending away from the base portion 214 on thesecond end 208. The cut guide 200 may be, for example, a right foot cutguide. A mirror image of the cut guide 200 for, for example, a left footis also contemplated. The cut guide 200 may provide, for example, fortransverse plane correction angles of approximately 16°, 18° and 20°,although alternative angles of correction are also contemplated.

As shown in FIGS. 11, 15 and 16 , the top surface 202 of the baseportion 214 may be, for example, curved or arced between the first side210 and the second side 212. In one embodiment, the top surface 202 ofthe base portion 214 may include, for example, a flat or planar portionpositioned between a first curvature or arc extending from the firstside 210 to the flat portion and a second curvature or arc extendingfrom a second side 212 to the flat portion. The end of the base portion214 near the first end 206 of the cut guide 200 may be, for example,angled from the second side 212 to the first side 210, as shown in FIG.17 . The end of the base portion 214 near the second end 208 of the cutguide 200 may extend, for example, perpendicularly between the firstside 210 and the second side 212, as shown in FIG. 17 .

The base portion 214 also includes at least one slot 216, 218, 220, 222,as shown in FIGS. 11-14, 17 and 18 . In the depicted embodiment, thebase portion 214 includes a first slot 216 adjacent to a second slot 218and a third slot 220 adjacent to a fourth slot 222. The first and secondslots 216, 218 are positioned on the base portion 214 near the secondend 208 of the cut guide 200 and the third and fourth slots 220, 222 arepositioned on the base portion 214 near the first end 206 of the cutguide 200. The slots 216, 218, 220, 222 may extend, for example,linearly or angled through the base portion 214 from the top surface 202to the bottom surface 204 of the cut guide 200. The slots 216, 218, 220,222 may be, for example, angled approximately 1° to 4° and morespecifically, approximately 2°, as the slots 216, 218, 220, 222 extendbetween the top and bottom surfaces 202, 204. It is also contemplatedthat some of slots 216, 218, 220, 222 may be angled and other slots 216,218, 220, 222 may be linear as they extend through the base portion 214from the top surface 202 to the bottom surface 204.

In addition, the slots 216, 218 may be oriented, for example, relativelyperpendicular to the first side 210 and the second side 212 as the slots216, 218 extend from the first side 210 to the second side 212, as shownin FIGS. 11-14, 17 and 18 . The slots 220, 222 may be, for example,angled as the slots 220, 222 extend between the second side 212 and thefirst side 210. The slots 220, 222 may also be, for example, angledtoward the slots 216, 218, as the slots 220, 222 extend from the secondside 212 to the first side 210. The slots 220, 222 may also bepositioned to extend parallel to the end of the base portion 214 nearthe second end 208 of the cut guide 200. The slots 220, 222 may be, forexample, angled between approximately 2° and 30°, and more specificallybetween approximately 8° and 22° as the slots 220, 222 extend from thesecond side 212 to the first side 210 providing for an angulationcorrection of 8° to 22° in the transverse plane. The slots 216, 218,220, 222 may be configured or sized and shaped to receive a saw bladeand may have a width of, for example, approximately 0.58 mm to 0.92 mm.The slots 216, 218, 220, 222 may be positioned, for example, to allowfor removal of the articular cartilage layer at the ends of the twobones. To prevent resecting more tissue than absolutely necessary, theslots 216, 218, 220, 222 may be positioned, for example, such that themedial portion of the slots 216, 218, 220, 222 are aligned with theintersection of the cartilage and bone.

The base portion 214 may also include a hole or dorsal hole 224, asshown in at least FIGS. 12, 13, 17 and 18 . The hole 224 is positionedbetween the second slot 218 and the third slot 220 near the second side212 of the base portion 214. The hole 224 may extend, for example, intothe base portion 214 from the top surface 202 of the cut guide 200 andto a point within the extension member 228. As shown in FIGS. 12, 15, 16and 18 , as the hole 224 extends into the extension member 228, the hole224 forms an opening in a proximal-distal direction through theextension member 228. The hole 224 may, for example, extend into the cutguide 200 parallel to the angled portion of the extension member 228, asshown in FIG. 12 . The hole 224 may be sized and shaped or configured,for example, to receive a wire, alignment wire, k-wire, guide wire orthe like to provide information on the position of the cut guide 200 ina joint. For example, a wire inserted into hole 224 should alignapproximately with the long axis of the patient's tibia to provide theproper orientation of the cut guide 200 in the joint, which may be, forexample, approximately 45° from dorsal and 45° from medial in thefrontal plane.

Referring now to FIGS. 11-14 and 18 , the base portion 214 also includesa recessed region 226 positioned on the bottom surface 204. The recessedregion 226 extends from the first side 210 to the second side 212 andinto the base portion 214 from the bottom surface 204 toward the topsurface 202. The recessed region 226 extends to engage the bonecontacting surface 236 of the first arm 230 at the first side 210 of thebase portion 214. The extension member 228 is coupled to the recessedregion 226 of the base portion 214 and extends away from the recessedregion 226 of the base portion 214. In addition, the extension member228 is positioned between the second slot 218 and the third slot 220.The extension member 228 also extends from the second side 212 towardthe first side 210, as shown in FIGS. 12, 15, 16 and 18 . The extensionmember 228 may include a perpendicular portion near the first side 210that extends perpendicularly away from the bottom surface 204. Theperpendicular portion of the extension member 128 may be, for example,angled when the cut guide 200 is inserted into a patient's joint and theangle that the perpendicular portion is positioned at may correspond tothe angle of the first tarso-metatarsal joint medially. The extensionmember 228 may also include an angled portion extending from the secondside 212 to the end of the extension member 228. The extension member228 may be shaped, for example, to fit within the joint space betweentwo bones, such as, a first metatarsal and cuneiform, as well as to matewith the articular joints. The angled portion of the extension member228 may, for example, be oriented laterally and should align with thelong axis of the tibia, as well as fit within the joint to rest againstthe relatively straight surface of the adjacent bone, for example, thesecond metatarsal. When the angled portion of the extension member 228is oriented against the second metatarsal, the cut guide 200 will bepositioned at a 45° angle in the frontal plane.

As shown in FIGS. 11, 12, 17 and 18 , the first or proximal arm 230 mayextend away from an end of the base portion 214 and may be, for example,tapered from the base portion 214 to the first end 206 of the cut guide200. The side of the first arm 230 on the first side 210 of the cutguide 200 may be, for example, longer than the side of the first arm 230on the second side 212 of the cut guide 200. The first arm 230 includesat least one opening 232, 234. In the depicted embodiment, the first arm230 includes a first opening 232 and a second opening 234 positionednear the first end 206. The first opening 232 may be spaced apart fromthe second opening 234. The openings 232, 234 may extend from a topsurface 202 to a bottom surface 204 of the cut guide 200. The openings232, 234 may extend through the first arm 230, for example, parallel tothe extension member 228, angled as they extend from the top surface 202toward the bottom surface 204, or a combination of parallel and angled.In one embodiment, the first opening 232 may extend, for example,parallel to the extension member 228 and the second opening 234 may be,for example, angled with respect to the extension member 228.Alternative combinations of the orientations of the openings 232, 234are also contemplated, as would be understood by one of ordinary skillin the art from the above description. The first arm 230 may be shapedto provide a bone contacting surface 236 that corresponds to the shapeor surface of the bone that it will engage. The first arm 230 may be,for example, curved or arced as it extends between the first side 210and the second side 212 of the cut guide 200.

As shown in FIGS. 11, 12, 17 and 18 , the second or distal arm 240 mayextend away from an end of the base portion 214 and may be, for example,tapered from the base portion 214 to the second end 208 of the cut guide200. The second arm 240 also includes at least one opening 242, 244. Inthe depicted embodiment, the second arm 240 includes a third opening 242and a fourth opening 244 positioned near the second end 208. The thirdopening 242 may be spaced apart from the fourth opening 244. Theopenings 242, 244 may extend from a top surface 202 to a bottom surface204 of the cut guide 200. The openings 242, 244 may extend through thesecond arm 240, for example, parallel to the extension member 228,angled as they pass from the top surface 202 to the bottom surface 204,or a combination of parallel and angled. In one embodiment, the thirdopening 242 may extend, for example, parallel to the extension member228 and the fourth opening 244 may be, for example, angled with respectto the extension member 228. Alternative combinations of the openings242, 244 orientations are also contemplated, as would be understood byone of ordinary skill in the art from the above description. In oneembodiment, the holes 232, 242 may be, for example, positioned such thatthey are parallel to one another as they extend between the top andbottom surfaces 202, 204. By positioning the holes 232, 242 parallel toeach other, the cut guide 200 may be, for example, removed from guidewires inserted through holes 232, 242 without removing the guide wires.In addition, parallel holes 232, 242 allow for the relative rotationbetween the two guide wires to be measured or calculated after the bonesare cut using cut guide 200. Further, the holes 232, 242 may be, forexample, spaced apart from the extension member 228 a standard or setdistance to allow for interchangeability with alternative cut guides100, 250, 300, 400, if a different or additional resection is needed.The second arm 240 may be shaped to provide a bone contacting surface246 that corresponds to the surface or shape of the bone that it willengage. The second arm 240 may be, for example, curved or arced as itextends between the first side 210 and the second side 212. The secondarm 240 may have, for example, a larger length and width than the firstarm 230.

The openings 232, 234, 242, 244 may be positioned such that wiresinserted into the first and second openings 232, 234 cross above the cutguide 200 and wires inserted into the third and fourth openings 242, 244cross above the cut guide 200. By positioning the openings 232, 234 andopenings 242, 244 such that inserted wires cross above the openings 232,234 and openings 242, 244, respectively, the surgeon may make a smallersurgical incision and reduce the interaction or interference with otherinstruments during the procedure. The openings 232, 234, 242, 244 beingpositioned to allow the wires to cross also allows for the cut guide 200to be, for example, suspended above and/or in contact with the bonesurfaces being cut. Suspending the cut guide 200 above the bone surfacesprevents the cut guide 200 from being angled or tilted on the irregularbone surface and avoids moving the slots 216, 218, 220, 222, which wouldaffect the proposed cut angles.

Referring now to FIGS. 19-26 , yet another cut guide 250 is shown. Thecut guide 250 includes a top surface 252, a bottom surface 254, a firstor proximal end 256, a second or distal end 258, a first or medial side260, and a second or lateral side 262. The top surface 252 may be, forexample, narrower than the top surface 202 of cut guide 200 to providefor smaller angular corrections. The cut guide 250 also includes a baseportion 264, a paddle, fin or extension member 278 extending away fromthe bottom surface 254 of the base portion 264, a first or proximal arm280 extending away from the base portion 264 on a first end 256, and asecond or distal arm 290 extending away from the base portion 264 on asecond end 258. The cut guide 250 may be, for example, a right foot cutguide. A mirror image of the cut guide 250 for, for example, a left footis also contemplated. The cut guide 250 may provide, for example, fortransverse plane correction angles of approximately 2°, 4°, 6°, 8°, 10°,12° and 14°, although alternative angles are also contemplated.

As shown in FIGS. 19, 23 and 24 , the top surface 252 of the baseportion 264 may be, for example, curved or arced between the first side260 and the second side 262. The top surface 252 of the base portion 264may include, for example, a flat or planar portion positioned between afirst curvature or arc extending from the first side 260 to the flatportion and a second curvature or arc extending from the second side 262to the flat portion, as shown in FIGS. 23 and 24 . The end of the baseportion 264 near the first end 256 of the cut guide 250 may be, forexample, angled from the second side 262 to the first side 260, as shownin FIG. 25 . The end of the base portion 264 near the second end 258 ofthe cut guide 250 may extend, for example, perpendicularly between thefirst side 260 and the second side 262, as shown in FIG. 25 .

The base portion 264 also includes at least one slot 266, 268, 270, 272,as shown in FIGS. 19-22, 25 and 26 . In the depicted embodiment, thebase portion 264 includes a first slot 266 adjacent to a second slot 268and a third slot 270 adjacent to a fourth slot 272. The first and secondslots 266, 268 are positioned on the base portion 264 near the secondend 258 of the cut guide 250 and the third and fourth slots 270, 272 arepositioned on the base portion 264 near the first end 256 of the cutguide 250. The slots 266, 268, 270, 272 may extend, for example,linearly through the base portion 264 from the top surface 252 to thebottom surface 254. The slots 266, 268, 270, 272 may also be, forexample, angled as the slots 266, 268, 270, 272 extend from the topsurface 252 to the bottom surface 254. The slots 266, 268, 270, 272 maybe angled, for example, approximately 1° to 4° an more specifically,approximately 2°, as the slots 266, 268, 270, 272 extend from the topsurface 252 to the bottom surface 254. It is also contemplated that someof the slots 256, 258, 230, 232 may be angled and other slots 256, 258,260, 262 may be linear as they extend through the base portion 254 fromthe top surface 252 to the bottom surface 254.

The slots 266, 268 may also extend, for example, relativelyperpendicular to the first side 260 and the second side 262 as the slots266, 268 extend from the first side 260 to the second side 262, as shownin FIGS. 19-22, 25 and 26 . The slots 270, 272 may be, for example,angled as the slots 270, 272 extend between the second side 262 and thefirst side 260. The slots 270, 272 may also be, for example, angledtoward the slots 266, 268 as the slots 270, 272 extend from the secondside 262 to the first side 260. The slots 270, 272 may be positioned toextend parallel to the end of the base portion 264 near the first end256 of the cut guide 250. The slots 270, 272 may be, for example, angledat approximately 10°, 12°, 14°, and 16° as they extend between the firstside 260 and the second side 262 providing for angulation corrections of8°, 10°, 12°, and 14°, respectively. The slots 266, 268, 270, 272 may beconfigured or sized and shaped to receive a saw blade and may have awidth of, for example, approximately 0.58 mm to 0.92 mm. The slots 266,268, 270, 272 may be positioned, for example, to allow for removal ofthe articular cartilage. To prevent resecting more tissue thanabsolutely necessary, the slots 266, 268, 270, 272 may be positioned,for example, such that the medial portion of the slots 266, 268, 270,272 are aligned with the intersection of the cartilage and bone or thecartilage-bone line.

The base portion 264 may also include a hole or dorsal hole 274, asshown in at least FIGS. 19-21 and 23-26 . The hole 274 is positionedbetween the second slot 268 and the third slot 270 near the second side262 of the base portion 264. The hole 274 may extend, for example,through the base portion 264 from the top surface 252 of the cut guide250 and to an intersection point within the extension member 278. Asshown in FIGS. 23, 24 and 26 , as the hole 274 extends into theextension member 278, the hole 274 forms an opening in a proximal-distaldirection through the extension member 278. The hole 274 may, forexample, extend into the cut guide 250 parallel to the angled portion ofthe extension member 278, as shown in FIGS. 20, 23 and 24 . The hole 274may also be sized and shaped or configured, for example, to receive awire, alignment wire, k-wire, guide wire or the like to provideinformation on the position of the cut guide 250 in a joint. Forexample, the wire inserted into hole 274 should align approximately withthe long axis of the tibia to provide the proper orientation of the cutguide 250 relative to the joint, which may be, for example,approximately 45° from dorsal and 45° from medial in the frontal plane.

Referring now to FIGS. 19-22 and 26 , the base portion 264 may alsoinclude a recessed region 276 positioned on the bottom surface 254. Therecessed region 276 extends from the first side 260 to the second side262 and into the base portion 264 from the bottom surface 254 toward thetop surface 252. The extension member 278 is coupled to the recessedregion 276 of the base portion 264 and extends away from the recessedregion 276. In addition, the extension member 278 is positioned betweenthe second slot 268 and the third slot 270 and extends from the secondside 262 toward the first side 260, as shown in FIGS. 20, 23, 24 and 26. The extension member 278 may include a perpendicular portion near thefirst side 260 that extends perpendicularly away from the bottom surface254. The perpendicular portion of the extension member 278 may be, forexample, angled when the cut guide 250 is inserted into a patient'sjoint and the angle that the perpendicular portion is positioned at maycorrespond to the angle of the first tarso-metatarsal joint medially.The extension member 278 may also include an angled portion extendingfrom the second side 262 to the end of the extension member 278. Theextension member 278 may be shaped, for example, to fit within the jointspace between two adjacent bones, such as, a first metatarsal andcuneiform, as well as to make contact with the two side of an articularjoint. The angled portion of the extension member 278 may, for example,be oriented laterally and should align with the long axis of the tibia,as well as fit within the joint to rest against the relatively straightsurface of the adjacent bone, for example, the second metatarsal. Whenthe angled portion of the extension member 228 is oriented against thesecond metatarsal, the cut guide 250 will be positioned at a 45° anglein the frontal plane.

As shown in FIGS. 19, 20, 25 and 26 , the first or proximal arm 280 mayextend away from an end of the base portion 264 and may be, for example,tapered from the base portion 264 to the first end 256 of the cut guide250. The side of the first arm 280 on the first side 260 of the cutguide 250 may be, for example, longer than the side of the first arm 280on the second side 262 of the cut guide 250. The first arm 280 includesat least one opening 282, 284. In the depicted embodiment, the first arm280 includes a first opening 282 and a second opening 284 positionednear the first end 256. The first opening 282 may be spaced apart fromthe second opening 284. The openings 282, 284 may extend from a topsurface 252 to a bottom surface 254 of the cut guide 250. The openings282, 284 may extend through the first arm 280, for example, parallel tothe extension member 278, angled as they extend from the top surface 252toward the bottom surface 254, or a combination of parallel and angledorientations. In one embodiment, the first opening 282 may extend, forexample, parallel to the extension member 278 and the second opening 284may be, for example, angled with respect to the extension member 278.Alternative, combinations of orientations of the openings 282, 284 arealso contemplated, as would be understood by one of ordinary skill inthe art from the above description. The first arm 280 may be shaped toprovide a bone contacting surface 236 that corresponds to the shape ofthe bone that it will engage. The first arm 280 may be, for example,curved or arced as it extends between the first side 260 and the secondside 262 of the cut guide 250.

As shown in FIGS. 19, 20, 25 and 26 , the second or distal arm 290 mayextend away from an end of the base portion 264 and may be, for example,tapered from the base portion 264 to the second end 258 of the cut guide250. The second arm 290 includes at least one opening 292, 294. In thedepicted embodiment, the second arm 290 includes a third opening 292 anda fourth opening 294 positioned near the second end 258. The thirdopening 292 may be spaced apart from the fourth opening 294. Theopenings 292, 294 may extend from the top surface 252 to the bottomsurface 254 of the cut guide 250. The openings 292, 294 may extendthrough the second arm 290, for example, parallel to the extensionmember 278, angled as they extend from the top surface 252 toward thebottom surface 254, or a combination of parallel and angled. In oneembodiment, the third opening 292 may extend, for example, parallel tothe extension member 278 and the fourth opening 294 may be, for example,angled with respect to the extension member 278. Alternativecombinations of the orientations of the openings 292, 294 are alsocontemplated, as would be understood by one of ordinary skill in the artfrom the above description. In one embodiment, the openings 282, 292 maybe, for example, positioned such that they are parallel to one anotheras they extend between the top and bottom surfaces 252, 254. Bypositioning the openings 282, 292 parallel to each other, the cut guide250 may be, for example, removed from guide wires inserted throughopenings 282, 292 without removing the guide wires. In addition,parallel openings 282, 292 allow for the relative rotation between thetwo guide wires to be measured or calculated after the bones are cutusing cut guide 250. Further the openings 282, 292 may be, for example,spaced apart from the extension member 278 a standard or set distance toallow for interchangeability with alternative cut guides 100, 200, 300,400, if a different or additional resection is needed. The second arm290 may be shaped to provide a bone contacting surface 296 thatcorresponds to the shape of the bone surface that it will engage. Thesecond arm 290 may be, for example, curved or arced as it extendsbetween the first side 260 and the second side 262. The second arm 290may have, for example, a larger length and width than the first arm 280.

The openings 282, 284, 292, 294 may be positioned such that wiresinserted into the first and second openings 282, 284 and wires insertedinto the third and fourth openings 292, 294 all cross above the cutguide 250. By positioning the openings 282, 284 and openings 292, 294such that inserted wires cross above the openings 282, 284 and openings292, 294, respectively, the surgeon can make a smaller surgical incisionand reduce the interaction or interference with other instruments duringthe procedure. The openings 282, 284, 292, 294 being positioned to allowwires to cross also allows for the cut guide 250 to be, for example,suspended above and/or in contact with the bone surfaces being cut.Suspending the cut guide 250 above the bone surfaces prevents the cutguide 250 from being tilted on the irregular bone surface and thereforeavoids moving the slots 282, 284, 292, 294, which would affect theproposed cut angles.

Another cut guide 300 is shown in FIGS. 27-34 . The cut guide 300includes a top surface 302, a bottom surface 304, a first end 306, asecond end 308, a first side 310, and a second side 312. The first end306 may be, for example, a proximal end, and the second end 308 may be,for example, a distal end, or vice versa. The first side 310 may be, forexample, a medial side, and the second side 312 may be, for example, alateral side, or vice versa. The cut guide 300 also includes a baseportion 314, a paddle, fin or extension member 322 extending away fromthe bottom surface 304 of the base portion 314, and an arm 330 extendingaway from the base portion 314 on the second end 308. As shown in FIGS.27-34 , the cut guide 300 may be, for example, a right foot cut guide.The cut guide 300 may provide, for example, a 4° angulation from dorsalto plantar on the metatarsal.

Cut guide 300 may be used, for example, when a surgeon decides thatcorrection of the first metatarsal in plantarflexion is not sufficientenough and needs to take off more of the metatarsal from the dorsal toplantar direction. Alternatively, cut guide 300 may be used, forexample, when a surgeon knows from pre-operative radiographs that thefirst ray is dorsiflexed in order to cut more bone of the metatarsalplantarly to correct the dorsiflexion. For example, when guide 300 isused, it will be inserted into the patient's joint, the surgeon will usecut guide 300 to cut the first metatarsal, then cut guide 300 will beremoved and replaced with another cut guide, such as, cut guide 100,200, 250, to cut the cuneiform. The second guide 100, 200, 250 will beselected based on the size and desired angular correction of thecuneiform. The cut guide 300 may be removed from the patient's bones,for example, by sliding the guide 300 off a guide wire inserted throughthe opening 332 and inserting the second cut guide 100, 200, 250 ontothe guide wire to properly align the second cut guide 100, 200, 250 onthe patient's bones with respect to the first cut made to themetatarsal.

As shown in FIGS. 27, 31 and 32 , the top surface 302 of the baseportion 314 may be, for example, curved or arced between the first side310 and the second side 312. In an embodiment, the top surface 302 ofthe base portion 314 may include, for example, a flat or planar portionpositioned between a first curvature or arc extending from the firstside 310 to the flat portion and a second curvature or arc extendingfrom the second side 312 to the flat portion. The base portion 314 alsoincludes at least one slot 316, 318, as shown in FIGS. 27-30, 33 and 34. In the depicted embodiment, the first slot 316 is positioned adjacentto a second slot 318. The slots 316, 318 may extend, for example,through the base portion 314 from the top surface 302 to the bottomsurface 304 of the cut guide 300. The slots 316, 318 may be, forexample, angled as the slots 316, 318 extend from the top surface 302 tothe bottom surface 304. The slots 316, 318 may be angled, for example,approximately 1° to 4° and more specifically, approximately 2°, as theslots 316, 318 extend between the top surface 302 and the bottom surface304. It is also contemplated that the interior slot 316 may be angledwhile the exterior slot 318 may be linear as they extend between the topand bottom surfaces 302, 304.

In addition, the slots 316, 318 may be angled as they extend across thebase portion 314 from the first side 310 to the second side 312, asshown in FIGS. 33 and 34 . The slots 316, 318 may be, for example,angled at approximately 6° as they extend between the first and secondsides 310, 312 providing for an angulation correction of 4°. The slots316, 318 may be configured or sized and shaped to receive a saw bladeand may have a width of, for example, approximately 0.58 mm to 0.92 mm.As shown in FIG. 33 , the slots 316, 318 may be angled from adistal-medial position to a proximal-lateral position of the cut guide300. The slots 316, 318 may be positioned, for example, to allow forremoval of the articular cartilage only. To prevent resecting too muchtissue, the slots 316, 318 may be positioned, for example, such that themedial portion of the slots 316, 318 are aligned with the cartilage andbone boundary.

The base portion 314 also includes a hole or dorsal hole 320, as shownin at least FIGS. 27-29, 33 and 34 . The hole 320 is positioned betweenthe second slot 318 and the arm 330. The hole 320 may extend, forexample, through the base portion 314 from the top surface 302 to thebottom surface 304. The hole 320 may, for example, extend through thebase portion 314 of the cut guide 300 parallel to the angled portion ofthe extension member 322, as shown in FIG. 27 . The hole 320 may besized and shaped or configured, for example, to receive a wire,alignment wire, k-wire, guide wire, directional wire or the like toprovide information on the position of the cut guide 300 in a joint. Forexample, the wire inserted into hole 320 should align approximately withthe long axis of the tibia to provide the proper orientation of the cutguide 300 in the joint, which may be, for example, approximately 45°from dorsal and 45° from medial in the frontal plane.

Referring now to FIGS. 28-32 and 34 , the extension member 322 isattached to a bottom surface 304 of the base portion 314. The extensionmember 322 also extends away from the base portion 314 and is positionedon the first end 306 of the cut guide 300. In addition, the extensionmember 322 extends from the second side 312 toward the first side 310,as shown in at least FIGS. 28, 31 and 32 . The extension member 322 mayinclude a portion near the first side 310 that extends perpendicularlyaway from the bottom surface 304. The perpendicular portion of theextension member 322 may be, for example, angled when the cut guide 300is inserted into a patient's joint and the angle that the perpendicularportion is positioned at may correspond to the angle of the firsttarso-metatarsal joint medially. The extension member 322 may alsoinclude an angled portion extending from the second side 312 to the endof the extension member 322. The extension member 322 may be shaped, forexample, to fit within the joint space between the two bones, such as, afirst metatarsal and cuneiform, as well as to mate with the two sides ofan articular joint. The angled portion of the extension member 322 may,for example, be oriented laterally and should align with the long axisof the tibia, as well as fit within the joint to rest against therelatively straight surface of the adjacent bone, for example, thesecond metatarsal. When the angled portion of the extension member 322is oriented against the second metatarsal, the cut guide 300 will bepositioned at a 45° angle in the frontal plane.

As shown in FIGS. 27-30 and 32-34 , the arm 330 may extend away from anend of the base portion 314 and may be, for example, tapered from thebase portion 314 to the second end 308 of the cut guide 300. The arm 330may be, for example, a distal arm. The arm 330 may include at least oneopening 332, 334. In the depicted embodiment, the arm 330 includes afirst opening 332 and a second opening 334 positioned near the secondend 308. The first opening 332 may be spaced apart from the secondopening 334. The openings 332, 334 may extend from a top surface 302 toa bottom surface 304 of the cut guide 300. The openings 332, 334 mayextend through the arm 330, for example, parallel to the extensionmember 322, be angled as the openings 332, 334 extend from the topsurface 302 toward the bottom surface 304, or a combination of beingparallel and angled. In one embodiment, the first opening 332 mayextend, for example, parallel to the extension member 322 and the secondopening 334 may be, for example, angled with respect to the extensionmember 322 resulting in the inserted wires, guide wires, k-wires and thelike to cross above the cut guide 300. By positioning the openings 332,334 such that the inserted wires cross above the openings 332, 334, thesurgeon may make a smaller surgical incision and there will be lessinteraction or interference with other instruments during the procedure.Alternative combinations of the orientations of the openings 332, 334are also contemplated, as would be understood by one of ordinary skillin the art from the above description. The arm 330 may be shaped, forexample, to provide a bone contacting surface 336 that corresponds tothe surface or shape of the bone that the arm 330 will engage. The arm330 may be, for example, curved or arced as it extends between the firstside 310 and the second side 312.

Referring now to FIGS. 35 and 36 , another cut guide 350 is shown. Asshown, the cut guide 350 may be a mirror image of the cut guide 300 in amedial-lateral direction, therefore, the cut guide 350 will not bedescribed in full detail for brevity purposes. Therefore, the cut guide350 may be, for example, for a left foot. The cut guide 350 may includea top surface 352, a bottom surface 354, a first or proximal end 356, asecond or distal end 358, a first or medial side 360, and a second orlateral side 362, which may be as described above with respect to thetop surface 302, the bottom surface 304, the first or proximal end 306,the second or distal end 308, the first or medial side 310, and thesecond or lateral side 312, respectively, which will not be describedagain here for brevity sake. As the cut guide 350 is a mirror image ofthe cut guide 300, the cut guide 350 may also include a base portion 364which may be the mirror image of the base portion 314 as describedabove. In addition, the hole 320 is positioned on a left side of the cutguide 300 when in an insertion position and the hole 370 is positionedon the right side of the cut guide 350 when in an insertion position.The slots 366, 368 and the hole 370 may be similar to the slots 316, 318and hole 320, as described in greater detail above. Specifically, as thecut guide 350 is a mirror image of the cut guide 300, the slots 366, 368may be angled from a distal-lateral position to a proximal-medialposition of the cut guide 350 resulting in 4° of cumulative dorsal toplantar cutting, as described in greater detail above with reference tocut guide 300. Further, the cut guide 350 may include a fin, paddle orextension member 372 and an arm 380, which may be as described abovewith respect to the fin, paddle or extension member 322 and the arm 330,respectively. The openings 382, 384 and bone contacting surface 386 maybe as described above with reference to the openings 332, 334 and bonecontacting surface 336, which will not be described again here forbrevity purposes.

Another cut guide 400 is shown in FIGS. 37-44 . The cut guide 400includes a top surface 402, a bottom surface 404, a first end 406, asecond end 408, a first side 410, and a second side 412. The first end406 may be, for example, a proximal end, and the second end 408 may be,for example, a distal end, or vice versa. The first side 410 may be, forexample, a medial side, and the second side 412 may be, for example, alateral side, or vice versa. The cut guide 400 also includes a baseportion 414, a paddle, fin or extension member 418 extending away fromthe bottom surface 404 of the base portion 414, and an arm 420 extendingaway from the base portion 414 on the second end 408. The cut guide 400may be, for example, used on a right foot or a left foot.

The cut guide 400 may be, for example, used after any one of cut guides100, 150, 200, 250, 300, 350 to take off additional tissue or bone whenthe original cut does not take off enough tissue or bone. The cut guide400 may be positioned so that the extension member 418 is against andparallel to a previous cut in the joint, to cut away additional tissueor bone without changing the angulation of the prior cut.

As shown in FIGS. 41 and 42 , the top surface 402 of the base portion414 may be, for example, curved or arced between the first side 410 andthe second side 412. In an embodiment, the top surface 402 of the baseportion 414 may include, for example, a flat or planar portionpositioned between a first curvature or arc extending from the firstside 410 to the flat portion and a second curvature or arc extendingfrom a second side 412 to the flat portion. The base portion 414 alsoincludes at least one slot 416, as shown in FIGS. 37-40, 43 and 44 . Inthe depicted embodiment, the slot 416 is positioned near a center orlongitudinal axis of the base portion 414. The slot 416 may extend, forexample, linearly through the base portion 414 from the top surface 402to the bottom surface 404 of the cut guide 400. The slot 416 may alsobe, for example, positioned parallel with the extension member 418, asthe slot 416 extends from between the top surface 402 and the bottomsurface 404. The slot 416 may be positioned, for example, to allow forremoval of the articular cartilage layer of the bones. To preventresecting more bone than absolutely necessary, the slot 416 may bepositioned, for example, such that the medial portion of the slot 416 isaligned with the cartilage-bone border. The slot 416 may be positioned,for example, a first distance from the extension member 418. The slot416 may be configured or sized and shaped to receive a saw blade and mayhave a width of, for example, approximately 0.58 mm to 0.92 mm.

Referring now to FIGS. 37-42 and 44 , the extension member 418 iscoupled to a bottom surface 404 of the base portion 414. The extensionmember 418 also extends away from the base portion 414 and is positionedon the first end 406 of the cut guide 400. In addition, the extensionmember 418 extends from the second side 412 to the first side 410, asshown in at least FIGS. 38, 41 and 42 . The extension member 418 may betapered and include a first angled portion extending from the first side410 to the end of the extension member 418 and a second angled portionextending from the second side 412 to the end of the extension member418. As the cut guide 400 may be used on either a right or left foot,extension member 418 is angled on both the first and second sides 410,412 to allow for an angled portion to mate with the lateral side of thejoint. Further, the angled portion may rest against the relativelystraight surface of the adjacent bone, for example, the secondmetatarsal. When an angled portion of the extension member 418 isoriented against the second metatarsal, the cut guide 400 will bepositioned at a 45° angle medial in the frontal plane. The extensionmember 418 may be shaped, for example, to fit within the joint spacebetween two bones, such as, a first metatarsal and cuneiform, as well asto mate with the surface of an articular joint.

As shown in FIGS. 37-40 and 42-44 , the arm 420 may extend away from anend of the base portion 414 and may be, for example, tapered from thebase portion 414 to the second end 408 of the cut guide 400. The portionof the arm 420 at the second end 408 of the cut guide 400 may be, forexample, angled as the arm 420 extends from the second side 412 to thefirst side 410. The arm 420 may be, for example, a distal arm. The arm420 may include at least one opening 422, 424. In the depictedembodiment, the arm 420 includes a first opening 422 and a secondopening 424 positioned near the second end 408. The first opening 422may be spaced apart from the second opening 424. The openings 422, 424may extend from the top surface 402 through the bottom surface 404. Theopenings 422, 424 may extend through the arm 420, for example, parallelto the extension member 418, angled with respect to the top surface 402and the bottom surface 404, or a combination of being parallel andangled. In one embodiment, the first opening 422 may extend, forexample, parallel to the extension member 418 and the second opening 424may be, for example, angled with respect to the extension member 418 tocause the inserted wires, guide wires, k-wires and the like to crossabove the cut guide 400. By positioning the openings 422, 424 such thatinserted wires cross above the openings 422, 424, a smaller surgicalincision may be made and less interaction or interference with otherinstruments will be experienced during the procedure. The openings 422,424 positioning the wires to cross also allows for the cut guide 400 tobe, for example, suspended above and/or against the bone surfaces beingcut. The ability to suspend the cut guide 400 above the bone surfacesprevents the cut guide 400 from being angled or tilted because of theinconsistent bone surface which avoids moving the slot 416 and preventsthe proposed cut angles from being moved. Alternative combinations ofthe orientations of the openings 422, 424 are also contemplated, aswould be understood by one of ordinary skill in the art from the abovedescription. The arm 420 may be shaped, for example, to provide a bonecontacting surface 426 that corresponds to the shape of the bone surfacethat the arm 420 will engage. The arm 420 may be, for example, curved orarced as it extends between the first side 410 and the second side 412.

With continued reference to the cut guide 400 of FIGS. 37-44 , analternative embodiment cut guide 430 and insertion handle 450 are shownin FIGS. 66-74 . The cut guide 430 includes a top surface 402, a bottomsurface 404, a first end 406, a second end 408, a first side 410, and asecond side 412, as described in greater detail above with reference tocut guide 400 and which will not be described again here for brevitysake. The cut guide 430 also includes a base portion 414, a paddle, finor extension member 418 extending away from the bottom surface 404 ofthe base portion 414, and an arm 420 extending away from the baseportion 414 on the second end 408, as described in greater detail abovewith reference to cut guide 400 and which will not be described againhere for brevity sake. The base portion 414 also includes at least oneslot 416, as also described in greater detail above with reference tocut guide 400 and which will not be described again here for brevitysake. The arm 420 may include at least one opening 422, 424, asdescribed in greater detail above with reference to cut guide 400 andwhich will not be described again here for brevity sake. The arm 420 maybe shaped, for example, to provide a bone contacting surface 426 thatcorresponds to the shape of the bone surface that the arm 420 willengage, as described in greater detail above with reference to cut guide400 and which will not be described again here for brevity sake. The cutguide 430 may be, for example, used on a right foot or a left foot.

As shown in FIGS. 66-69 and 71 , the cut guide 430 may also include arecess or opening 432 inset into the surface of the base portion 414 onthe first end 406. The recess 432 may have, for example, an oval, round,or a polygonal shaped recess for receiving a correspondingly shapedprotrusion 460 on an insertion handle 450. The insertion handle 450allows for a surgeon to apply pressure against a patient's joint toachieve maximum contact between the cut guide 430 and the previously cutbone. As shown in FIGS. 66-74 , the insertion handle 450 includes ahandle portion 452 with a stem portion 454 extending away from a distalend of the handle portion 452. The stem portion 454 includes a tip 456at the distal end of the stem portion 454. The tip 456 includes an endsurface 458 which may be, for example, angled with respect to theproximal end of the handle portion 452. The end surface 458 may be, forexample, angled to provide the desired angle for insertion of the cutguide 430. The insertion handle 450 may further include an engagementmember or protrusion 460 extending away from the end surface 458. Theengagement member 460 may be, for example, shaped to correspond to therecess 432 in the cut guide 430. The engagement member 460 may have, forexample, an oval, round or polygonal shape.

Referring now to FIGS. 45 and 46 , a guide system 500 is shown. Theguide system 500 includes a cut guide 100, 150, 200, 250, 300, 350 andan alignment guide 510. The guide system 500 may also include the cutguide or revision cut guide 400. The guide system 500 may also include aposition rotation device 550, as shown in FIG. 64 . Further, the guidesystem 500 may include at least one directional wire 606 and at leasttwo wires, guide wires, k-wires, or the like 608, 610, 612, 614, 616, asshown in FIGS. 57-59 . In the depicted embodiment of FIGS. 45 and 46 ,the guide system 500 includes the cut guide 100 and the alignment guide510. Although not shown, it is also contemplated that cut guides 150,200, 250, 300, 350 may be interchangeable with cut guide 100 in thebelow described method or alternatively, used in conjunction with thecut guide 100 as described in greater detail below. The variousembodiments of the cut guides 100, 150, 200, 250, 300, 350 are describedin greater detail above and will not be described again here for brevitysake. As shown in FIGS. 45 and 46 , the alignment guide 510 removablyengages the cut guide 100. The alignment guide 510 may, for example,couple to at least one slot 116, 118, 120, 122 of the cut guide 100. Inone embodiment, the alignment guide 510 couples to two slots 116, 118,120, 122 and, for example, it is preferable that the alignment guide 510couple to the two proximal slots 120, 122.

As shown in FIGS. 45-52 , the alignment guide 510 includes a baseportion 512 with a top surface 514, a bottom surface 516, a first end518, a second end 520, a first side 522, and a second side 524. The afirst end 518 may be, for example, a proximal end, a second end 520 maybe, for example, a distal end, a first side 522 may be, for example, amedial side, and a second side 524 may be, for example, a lateral side.The base portion 512 may also include at least one opening 526, 528, 530extending between the first end 518 and the second end 520. In thedepicted embodiment, the base portion 512 includes a first opening 526positioned near the first side 522, a third opening 530 positioned nearthe second side 524, and a second opening 528 positioned between thefirst opening 526 and the third opening 530, as shown in FIGS. 45-48 and50 . The openings 526, 528, 530 may be, for example, sized and shaped toreceive a wire, guide wire, k-wire, directional wire, or the like, asshown in FIGS. 55-59 .

The alignment guide 510 may also include a first extension member or legmember 532 extending away from a bottom surface 516 of the base portion512, as shown in FIGS. 45, 47-49, 51, and 52 . The first extensionmember 532 may include a first portion 534, a second portion 536 and afirst engagement member 538. The first portion 534 may be coupled to thebottom surface 516 of the base portion 512 at a first end, extend awayfrom a position near a center of the base portion 512 in the directionof the first end 518 at an angle, and be coupled to the second portion536 at a second end. The first end of the second portion 536 may extendfrom the second end of the first portion 534 in a direction toward thesecond end 520 of the base portion 512 and be coupled to the firstengagement member 538 at a second end. The first engagement member 538may be coupled to the second portion 536 at a first end and extend in aplantar direction away from the second portion 536 to a second end. Thesecond end of the first engagement member 538 may be shaped to engagethe slots in a cut guide, for example, the slots 116, 118, 120, 122 ofcut guide 100, as shown in FIGS. 45 and 46 . The second end of thesecond engagement member 546 may also engage the slots of alternativecut guides, such as, cut guides 150, 200, 250, 300, 350.

The alignment guide 510 may also include a second extension member orleg member 540 extending away from a bottom surface 516 of the baseportion 512, as shown in FIGS. 45, 47-49, 51, and 52 . The secondextension member 540 may include a third portion 542, a fourth portion544 and a second engagement member 546. The third portion 542 may becoupled to the bottom surface 516 of the base portion 512 at a firstend, extend away from a position near a center of the base portion 512in the direction of the second end 520 at an angle, and be coupled tothe fourth portion 544 at a second end. The first end of the secondextension member 540 may also couple to or engage the first end of thefirst extension member 532. The first end of the fourth portion 544 mayextend from the second end of the third portion 542 in a directiontoward the first end 518 of the base portion 512 and be coupled to thesecond engagement member 546 at a second end. The second engagementmember 546 may be coupled to the fourth portion 544 at a first end andextend in a plantar direction away from the fourth portion 544 to asecond end. The second end of the second engagement member 546 may beshaped to engage slots in a cut guide, for example, the slots 116, 118,120, 122 of cut guide 100, as shown in FIGS. 45 and 46 . The second endof the second engagement member 546 may also engage the slots ofalternative cut guides, such as, cut guides 150, 200, 250, 300, 350.

Referring now to FIGS. 45, 47-49, and 52 , the first extension member532 and second extension member 540 may be, for example, mirror imagesof each other as the members 532, 540 extend away from the bottomsurface 516 of the base portion 512. The extension members 532, 540 maybe shaped, for example, to form a triangular shape with the firstportion 534 forming a first side, the third portion 542 forming a secondside, and the second portion 536 and the fourth portion 544 togetherforming a third side. The shape of the extension members 532, 540 allowsfor the alignment guide 510 to be positioned with respect to a cut guide100, 150, 200, 250, 300, 350 to create a visual depiction of the angleof deformity correction in both the dorsal and lateral planes. The firstengagement member 538 may extend away from the second portion 536, forexample, generally parallel to the second engagement member 546 as thesecond engagement member 546 extends away from the fourth portion 544.The engagement members 538, 546 may extend away from the second andfourth portions 536, 544, respectively, for example, generallyperpendicular to the top surface 514 of the base portion 512.Alternatively, it is also contemplated that the engagement members 538,546 may extend, for example, away from the second and fourth portions536, 544, respectively, at an angle with respect to the top surface 514of the base portion 512. The extension members 532, 540 may act tocreate, for example, a spring like mechanism in the engagement members538, 546 to allow the engagement members 538, 546 to couple to the cutguides 100, 150, 200, 250, 300, 350.

The position rotation device 550 is shown in FIGS. 64 and 65 . Therotation device includes a base 552 with a top surface 554 opposite abottom surface 556. The base 552 also includes a first end 558 oppositea second end 560. The base 552 may be, for example, curved to form asemi-circle or arc as the base 552 extends from the first end 558 to thesecond end 560. The base 552 may also optionally include a centeralignment groove 562. The alignment groove 562 may be inset into a frontside of the base 552 and may extend from the top surface 554 through thebase 552 to the bottom surface 556.

With continued reference to FIGS. 64 and 65 , the base 552 furtherincludes a first or zero opening 564 positioned, for example, centeredbetween the first end 558 and the second end 560 of the base 552. Thezero opening 564 may be positioned adjacent to the first end 582 of theshaft 580. The zero opening 564 may also be positioned, for example,near a back side of the base 552. The zero opening 564 may have, forexample, an insertion angle for a guide wire, k-wire or the like of 0°as the opening 564 extends from the top surface 554 to the bottomsurface 556. The zero opening 564 may be used for positioning andaligning the position rotation device 550 on a patient. The zero opening564 may be, for example, sized and shaped or configured to receive aguide wire, k-wire or the like, for aligning the rotation device 550 ona patient's bone.

As shown in FIGS. 64 and 65 , the base 552 may also include a first setof overlapping openings 566. The openings 566 may be positioned alongthe front side of the rotation device 550 between the groove 562 and thefirst end 558. The base 552 may also include a second set of overlappingopenings 568. The openings 568 may be positioned along the front side ofthe rotation device 550 between the groove 562 and the second end 560.The base 552 may also include a third opening 570 positioned along thefront side of the rotation device 550 between the first set of openings566 and the first end 558. The base 552 may also include a fourthopening 572 positioned along the front side of the rotation device 550between the second set of openings 568 and the second end 560. Theopenings 566, 568, 570, 572 may be, for example, angled as they extendfrom the top surface 554 to the bottom surface 556. The first set ofoverlapping openings 566 and the second set of overlapping openings 568may each include, for example, three openings. The three overlappingopenings 566, 568 may each have an angle of rotation relative to thezero opening 564, for example, the openings 566, 568 closest to thegroove 562 may have a rotation angle of approximately 10° to 19°. Thenext openings 566, 568 may have a rotation angle of, for example,approximately 20° to 29° and the outer most opening 566, 568 from thegroove 562 may have a rotation angle of, for example, approximately 30°to 39°. Finally, the third and fourth openings 570, 572 may haverotation angles relative to the zero opening 564 of, for example,approximately 40° to 50°. In one embodiment, the rotation angles may be,for example, 15°, 25°, 35°, and 45°. In yet another embodiment, therotation angles may be, for example, 15°, 22°, 30°, and 45°. Theopenings 566, 568, 570, 572 may be positioned linearly along the base552 as it curves from the first end 558 to the second end 560 and offsetfrom the zero opening 564. Alternatively, each of the openings 566, 568,570, 572 may be, for example, offset from each other and the zeroopening 564.

Referring now to FIGS. 53-64 , a method of using the guide system 500 isshown. As shown in FIGS. 53-63 , the guide system 500 may include thecut guide 100, the alignment guide 510, the position rotation device550, at least one directional wire 606, and multiple guide wires 608,610, 612, 614, 616. Although FIGS. 53-63 show the method using the cutguide 100, it is also contemplated that the method may include using anyone of cut guides 100, 150, 200, 250, 700, 750, 800, 850, 900, 950.Alternatively, the method may include using a combination of one of cutguides 300, 350, 1000, 1050 on the first metatarsal and then any one ofcut guides 100, 150, 200, 250, 700, 750, 800, 850, 900, 950 on thecuneiform.

The method may include inserting the extension member 128 of the cutguide 100 into the joint space between a first bone or first metatarsal602 and a second bone or medial cuneiform 604, as shown in FIGS. 53 and54 . The extension member 128 fits between the first bone 602 and secondbone 604 to align the slots 116, 118, 120, 122 of the base portion 114to produce the desired angled cut. The slots 116, 118, 120, 122 may beangled relative to the extension member 128 to account for the extensionmember 128 shifting during resection of the bone. The extension member128 may be inserted so that the first arm 130 is positioned on thesecond bone 604 and the second arm 140 is positioned on the first bone602.

Next, the alignment guide 510 may be coupled to the cut guide 100, asshown in FIGS. 55 and 56 . The first engagement member 538 may be, forexample, inserted into a first slot 120, 122 and the second engagementmember 546 may be, for example, inserted into a second slot 120, 122.For example, as shown in FIGS. 55 and 56 , the first engagement member538 may be inserted in the slot 120 and the second engagement member 546may be inserted into the slot 122. The method may also include insertingat least one directional wire 606 into at least one opening 526, 528,530 in the alignment guide 510. As further shown in FIGS. 55 and 56 , adirectional wire 606 is inserted into the opening 530 in the alignmentguide 510. The directional wire 606 inserted into the alignment guide510 depicts the exact angle of deformity correction in both the dorsaland lateral planes. The mating of the engagement members 538, 546 andthe slots 120, 122 produces the resulting angle of correction andillustrates the correction angle during surgery.

After inserting a direction wire 606 into the alignment guide 510, themethod may optionally include changing the cut guide 100 to a cut guidewith a different angular size. For example, if the alignment guide 510shows an over-correction or under-correction of the hallux valgusdeformity, then the surgeon may go down or up an angular size of cutguide, respectively. Each of the cut guides 100, 150, 200, 250, 300,350, 700, 750, 800, 850, 900, 950, 1000, 1050 may have different angularsizes and/or be for a right or left foot. If the alignment guide 510shows an over-correction or under-correction, then the cut guide 100 maybe removed from the foot 600 and replaced with an alternative size cutguide 150, 200, 250, 300, 350. If the cut guide 700, 750 is used, thenthe cut guide 700, 750 may be removed from the foot 600 and replacedwith an alternative size cut guide 800, 850, 900, 950, 1000, 1050. Oncethe new cut guide is inserted into the foot 600, the surgeon mayre-check the correction by inserting the alignment guide 510 into thenew cut guide and the directional wire 606 into the alignment guide 510,as described in greater detail above, to determine whether the new cutguide provides the desired correction.

Once the cut guide 100, 150, 200, 250, 300, 350, 700, 750, 800, 850,900, 950, 1000, 1050 with the desired correction is inserted into thepatient's joint space, then a k-wire, guide wire or dorsal wire 608 maybe inserted into the dorsal hole 124 of the cut guide 100 between theslot 118 and the slot 120, as shown in FIGS. 57-59 . The guide wire 608may be used to check the orientation of the cut guide 100 by checkingthat the wire 608 is parallel to a patient's tibia and perpendicular tothe weight-bearing surface. After the desired orientation is achieved,k-wires, guide wires, wires 610, 612, 614, 616 may be inserted throughthe holes 132, 134, 142, 144 in the cut guide 100 and into the bones602, 604, to secure the cut guide 100 to the bones 602, 604, as shown inFIGS. 57-59 . For example, a distal-medial wire, k-wire, guide wire 610may be inserted into the fourth opening 144 in the cut guide 100, aproximal-medial wire, k-wire, guide wire 612 may be inserted into thesecond opening 134, a distal-lateral wire, k-wire, guide wire 614 may beinserted into the third opening 142, and a proximal-lateral wire,k-wire, guide wire 616 may be inserted into the first opening 132, asshown in FIGS. 57-59 .

Next, the dorsal k-wire 608 and the alignment guide 510 may be removedfrom the cut guide 100, as shown in FIGS. 60 and 61 . After the cutguide 100 is coupled to the bones 602, 604 and the alignment guide 510and dorsal k-wire 608 are removed from the cut guide 100, the bones 602,604 may be cut using the desired slots 116, 118, 120, 122, as shown inFIGS. 62 and 63 . For example, a saw blade 620 of saw 618 may beinserted through the first slot 116 to cut the first bone 602, as shownin FIG. 62 , then the saw blade 620 may be removed and inserted throughthe third slot 120 to cut the second bone 604, as shown in FIG. 63 .After the bones 602, 604 are cut, the lateral k-wires 614, 616 and thecut guide 100 may be removed from the bones 602, 604 and the medialk-wires 610, 612 may be left in the bones 602, 604, as shown in FIGS. 64. The medial k-wires 610, 612 may be positioned, for example, parallelto each other. If the angle of correction is not accurate the surgeonmay insert another cut guide 200, 250, 300 over the medial k-wires 610,612 and perform additional cutting to achieve the desired angle ofcorrection. Alternatively or additionally, if more tissue or bone needsto be removed from the patient's bones, then the cut guide 400 may beinserted over one of the medial k-wires 610, 612. The cut guide 400 maythen be positioned to align the extension member 418 against the cutsurface of the bone to remove additional tissue or bone parallel to theoriginal cut. Once the desired amount of tissue and/or bone is removedand the desired angle of correction achieved, a position rotation device550 may be slid over the medial k-wires 610, 612. The cartilage and bonethat was resected using the cut guide 100 may also be removed from thejoint, as shown in FIG. 64 .

After the bones 602, 604 have been cut and the resected bone andcartilage removed, the rotation device 550 may be inserted over thedistal-medial wire 610, as shown in FIG. 64 . The wire 610 may beinserted into the first opening 564 of the rotation device 550. Then, asecond k-wire (not shown) may be inserted into one of the openings 566,568, 570, 572 corresponding to the desired angulation correction. Afterthe second k-wire (not shown) is inserted through the selected opening566, 568, 570, 572, the distal-medial wire 610 may be removed from thebone 602 and the rotation device 550. Next, the rotation device 550 maybe removed from the foot 600. Then, the method may include rotating thebones 602, 604 to the desired correction where the second k-wire (notshown) in the first metatarsal 602 is positioned parallel to the k-wire612 in the medial cuneiform 604 and temporarily securing the bones 602,604 in the rotated position. Finally, the bones 602, 604 may be securedin the rotated position using a plate (not shown) and screws (notshown). Finally, the surgical procedure may include performing incisionclosure or concomitant procedures.

Referring now to FIGS. 75-82 , another cut guide 700 is shown. The cutguide 700 includes a top surface 702, a bottom surface 704, a first orproximal end 706, a second or distal end 708, a first or medial side710, and a second or lateral side 712. The cut guide 700 also includes abase portion 714 and a paddle, fin or extension member 728 extendingaway from the bottom surface 704 of the base portion 714. The cut guide700 further includes a first or proximal arm 730 extending away from thebase portion 714 on a first end 706 and a second or distal arm 740extending away from the base portion 714 on a second end 708. The cutguide 700 may be, for example, a right foot cut guide.

As shown in FIGS. 75, 79 and 80 , the top surface 702 of the baseportion 714 may be, for example, curved or arced between the first side710 and the second side 712. In one embodiment, the top surface 702 ofthe base portion 714 may include, for example, a flat or planar portionpositioned between a first curvature or arc extending from the firstside 710 to the flat portion and a second curvature or arc extendingfrom a second side 712 to the flat portion. The end of the base portion714 near the first end 706 of the cut guide 800 may be, for example,angled from the second side 712 to the first side 710, as shown in FIG.81 . The end of the base portion 714 near the second end 708 of the cutguide 700 may extend, for example, perpendicularly between the firstside 710 and the second side 712, as shown in FIG. 81 . The base portion714 also includes at least one slot 716, 718, 720, 722, as shown inFIGS. 75-78, 81 and 82 . In the depicted embodiment, the base portion714 includes a first slot 716 adjacent to a second slot 718 and a thirdslot 720 adjacent to a fourth slot 722. The first and second slots 716,718 may be, for example, positioned on the second end 708 of the baseportion 714 and the third and fourth slots 720, 722 may be, for example,positioned on the first end 706 of the base portion 714.

With continued reference to FIGS. 75-78 and 81 , the slots 716, 718,720, 722 may extend, for example, linearly through the base portion 714from the top surface 702 to the bottom surface 704 of the cut guide 700.Alternatively, the slots 716, 718, 720, 722 may also be, for example,angled as the slots 716, 718, 720, 722 extend from the top surface 702to the bottom surface 704. The slots 716, 718, 720, 722 may be angled,for example, approximately 1° to 4° and more specifically, approximately2°, as they extend between the top surface 702 and the bottom surface704. It is also contemplated that some of slots 716, 718, 720, 722 maybe angled and other slots 716, 718, 720, 722 may be linear as theyextend through the base portion 714 from the top surface 702 to thebottom surface 704.

In addition, the slots 716, 718, 720, 722 may be angled as they extendbetween the first side 710 and the second side 712, for example, theslots may be angled approximately 0° to 30° as the slots 716, 718, 720,722 extend between the first and second sides 710, 712. As shown, slots716, 718 have an angle of 0° as the slots 716, 718 extend between thefirst and second sides 710, 712 and slots 720, 722 have an angle of 8°as the slots 720, 722 extend between the first and second sides 710,712. Although not shown with respect to cut guide 700, it is alsocontemplated that both the first set of slots 716, 718 and the secondset of slots 720, 722 may be straight as the slots 716, 718, 720, 722extend between the first and second sides 710, 712. As shown, the slots720, 722 are positioned to extend between the first and second sides710, 712 parallel to the first metatarsal, as discussed in greaterdetail above with respect to the method of using the cut guide 700. Theslots 716, 718, 720, 722 may be configured or sized and shaped toreceive a saw blade and may have a width of, for example, approximately0.58 mm to 0.92 mm. The slots 716, 718, 720, 722 may be positioned, forexample, to allow for removal of the articular cartilage layer of thetwo bones. To prevent resecting more bone than absolutely necessary, theslots 716, 718, 720, 722 may be positioned, for example, such that themedial portion of the slots 716, 718, 720, 722 are aligned with theintersection of the cartilage and bone. In one embodiment, the slots716, 718 are positioned a first distance from the extension member 728,the slots 720, 722 are positioned a second distance from the extensionmember 728. The first distance may be measured from the extension member728 to an inner surface of the slots 716, 718 and the second distancemay be measured from the extension member 728 to an inner surface of theslots 720, 722.

The base portion 714 may also include a hole or dorsal hole 724, asshown in at least FIGS. 78, 81 and 82 . The hole 724 may be of the typedescribed above with reference to hole 124, which will not be describedagain here for brevity sake. As shown in FIGS. 75-78 and 82 , the baseportion 714 also includes a recessed region 726 positioned on the bottomsurface 704. The recessed region 726 extends from the first side 710 tothe second side 712 and into the base portion 714 a first distance fromthe bottom surface 704 toward the top surface 702. The extension member728 is coupled to the recessed region 726 of the base portion 714 andextends away from the recessed region 726 of the base portion 714. Inaddition, the extension member 728 is positioned between the second slot718 and the third slot 720 and also extends from the second side 712toward the first side 710, as shown in FIGS. 79, 80 and 82 . Theextension member 728 may be shaped, for example, to fit within the jointspace between two bones, such as, a first metatarsal and cuneiform, aswell as to make contact with the adjoining articular joint surfaces. Theextension member 728 may include a perpendicular portion near the firstside 710 that extends perpendicularly away from the bottom surface 704.The perpendicular portion of the extension member 728 may be, forexample, angled when the cut guide 700 is inserted into a patient'sjoint and the angle that the perpendicular portion is positioned at maycorrespond to the angle of the first tarso-metatarsal joint medially.The extension member 728 may also include an angled portion extendingfrom the second side 712 to the end of the extension member 728. Theangled portion of the extension member 728 may, for example, allow forthe extension member 728 to fit within a variety of anatomicpresentations. The angled portion of the extension member 728 may, forexample, be oriented laterally and should align with the long axis ofthe tibia, as well as fit within the joint to rest against therelatively straight surface of the adjacent bone, for example, thesecond metatarsal. When the angled portion of the extension member 728is oriented against the second metatarsal, the cut guide 700 will bepositioned at a 45° angle in the frontal plane.

As shown in FIGS. 75, 76, 81 and 82 , the first or proximal arm 730 mayextend away from an end of the base portion 714 and may have, forexample, a first portion extending from the base portion 714 to acoupling portion 738 positioned at the first end 706 of the cut guide700. The coupling portion 738 may have a width larger than the width ofthe first portion of the first arm 730. The coupling portion 738 of thefirst arm 730 includes at least one opening 732, 734. In the depictedembodiment, the first arm 730 includes a first opening 732 and a secondopening 734 positioned near the first end 706. The first opening 732 maybe spaced apart from the second opening 734. The openings 732, 734 mayextend from a top surface 702 to a bottom surface 704 of the couplingportion 738 of the cut guide 700. The openings 732, 734 may extendthrough the coupling portion 738 of the first arm 730, for example,parallel to the extension member 728, angled as they extend from the topsurface 702 toward the bottom surface 704, or a combination of paralleland angled. In one embodiment, the first opening 732 may extend, forexample, parallel to the extension member 728 and the second opening 734may be, for example, angled with respect to the extension member 728 topermit the inserted wires, guide wires, k-wires and the like to crossabove the cut guide 700 without intersecting. By positioning theopenings 732, 734 such that inserted wires cross above the openings 732,734 allows for a smaller surgical incision and less interaction orinterference with other instruments during the procedure. The openings732, 734 positioning the wires to cross also allows for the cut guide700 to be, for example, suspended above and/or proximate to the bonesurfaces being cut. The ability to suspend the cut guide 700 above thebone surfaces prevents the cut guide 700 from being titled because ofvarying patient anatomy and this avoids moving the slots 716, 718, 720,722 which would affect the proposed cut angles. Alternative combinationsof orientations of the openings 732, 734 are also contemplated, as wouldbe understood by one of ordinary skill in the art from the abovedescription. The first arm 730 may be shaped to provide a bonecontacting surface 736 that corresponds to the shape of the bone that itwill engage. The first arm 730 may be, for example, curved or arced asit extends between the first side 710 and the second side 712.

As shown in FIGS. 75, 76, 81 and 82 , the second or distal arm 740 mayextend away from an end of the base portion 714 and may have, forexample, a first portion extending from the base portion 714 to acoupling portion 748 positioned at the second end 708 of the cut guide700. The coupling portion 748 may have a width larger than the width ofthe first portion of the second arm 740. The coupling portion 748 of thesecond arm 740 includes at least one opening 742, 744. In the depictedembodiment, the second arm 740 includes a third opening 742 and a fourthopening 744 positioned near the second end 708. The third opening 742may be spaced apart from the fourth opening 744 and extend from a topsurface 702 to a bottom surface 704 of the cut guide 700. The openings742, 744 may extend through the second arm 740, for example, parallel tothe extension member 728, angled as they extend from the top surface 702toward the bottom surface 704, or a combination of parallel and angled.In one embodiment, the third opening 742 may extend, for example,parallel to the extension member 728 and the fourth opening 744 may be,for example, angled with respect to the extension member 728 to permitinserted wires, guide wires, k-wires, and the like to cross above thecut guide 700 without intersecting. By positioning the openings 742, 744such that the inserted wires cross above the openings 742, 744 allowsfor a smaller surgical incision and less interaction or interferencewith other instruments during the procedure. The openings 742, 744 beingpositioned for the wires to cross, also allows for the cut guide 700 tobe, for example, suspended above and/or mated with the bone surfacesbeing cut. Suspending the cut guide 700 above the bone surfaces preventsthe cut guide 700 from being angled because of varying patient anatomywhich results in not having to move the slots 716, 718, 720, 722 whichwould affect the proposed cut angles. In one embodiment, the openings732, 742 may be, for example, positioned such that they are parallel toone another as they extend between the top and bottom surfaces 702, 704.By positioning the openings 732, 742 parallel to each other, the cutguide 700 may be, for example, removed from guide wires inserted throughopenings 732, 742 without removing the guide wires. In addition,parallel openings 732, 742 allow for the relative rotation between thetwo guide wires to be measured or calculated after the bones are cutusing cut guide 700. Further, the openings 732, 742 may be, for example,spaced apart from the extension member 728 a standard or set distance toallow for interchangeability with alternative cut guides 800, 900, 1000,if a different or additional resection is needed. Alternative,combinations of orientations of the openings 742, 744 are alsocontemplated, as would be understood by one of ordinary skill in the artfrom the above description. The second arm 740 may be shaped to providea bone contacting surface 746 that corresponds to the shape of the bonethat it will engage. The second arm 740 may be, for example, curved orarced as it extends between the first side 710 and the second side 712.The second arm 740 may have, for example, a larger length than the firstarm 730.

Referring now to FIGS. 83 and 84 , another cut guide 750 is shown. Thecut guide 750 is a mirror image of the cut guide 700 in a medial-lateraldirection, which will not be described again in full detail for brevitypurposes. For example, the hole 724 is positioned on a left side of thecut guide 700 when in an insertion position and the hole 774 ispositioned on a right side of the cut guide 750 when in an insertionposition. The cut guide 750 may be, for example, for a left foot. Thecut guide 750 may include a top surface 752, a bottom surface 754, afirst or proximal end 756, a second or distal end 758, a first or medialside 760, and a second or lateral side 762, which may be of the typedescribed above with respect to the top surface 702, the bottom surface704, the first or proximal end 706, the second or distal end 708, thefirst or medial side 710, and the second or lateral side 712,respectively. The cut guide 750 may also include a base portion 764which may be the mirror image of the base portion 714, as describedabove. The slots 766, 768, 770, 772, the hole 774, and the recessedregion 776 may be the same or similar to the slots 716, 718, 720, 722,the hole 724, and the recessed region 726, as described in greaterdetail above. Further, the cut guide 750 may include a fin, paddle orextension member 778, a first or proximal arm 780, and a second ordistal arm 790, which may be as described above with respect to theextension member 728, the first arm 730, and the second arm 740,respectively. The coupling portion 788, the openings 782, 784 and thebone contacting surface 786 may be as described above with reference tothe coupling portion 738, the openings 732, 734 and the bone contactingsurface 736 and the coupling portion 798, the openings 792, 794 and thebone contacting surface 796 may be as described above with reference tothe coupling portion 748, the openings 742, 744 and the bone contactingsurface 746, which will not be described again here for brevitypurposes.

Referring now to FIGS. 85-92 , another cut guide 800 is shown. The cutguide 800 includes a top surface 802, a bottom surface 804, a first orproximal end 806, a second or distal end 808, a first or medial side810, and a second or lateral side 812. The cut guide 800 also includes abase portion 814, a paddle, fin or extension member 828 extending awayfrom the bottom surface 804 of the base portion 814, a first or proximalarm 830 extending away from the base portion 814 on the first end 806,and a second or distal arm 840 extending away from the base portion 814on the second end 808. The cut guide 800 may be, for example, a rightfoot cut guide.

As shown in FIGS. 85, 89 and 90 , the top surface 802 of the baseportion 814 may be, for example, curved or arced between the first side810 and the second side 812. In one embodiment, the top surface 802 ofthe base portion 814 may include, for example, a flat or planar portionpositioned between a first curvature or arc extending from the firstside 810 to the flat portion and a second curvature or arc extendingfrom a second side 812 to the flat portion. The end of the base portion814 near the first end 806 of the cut guide 800 may be, for example,angled from the first side 810 to the second side 812, as shown in FIG.91 . The end of the base portion 814 near the second end 808 of the cutguide 800 may extend, for example, perpendicularly between the firstside 810 and the second side 812, as shown in FIG. 91 .

The base portion 814 also includes at least one slot 816, 818, 820, 822,as shown in FIGS. 85-88, 91 and 92 . In the depicted embodiment, thebase portion 814 includes a first slot 816 adjacent to a second slot 818and a third slot 820 adjacent to a fourth slot 822. The first and secondslots 816, 818 are positioned on the base portion 814 near the secondend 808 of the cut guide 800 and the third and fourth slots 820, 822 arepositioned on the base portion 814 near the first end 806 of the cutguide 800. The slots 816, 818, 820, 822 may extend, for example,linearly or angled through the base portion 814 from the top surface 802to the bottom surface 804 of the cut guide 800. The slots 816, 818, 820,822 may be, for example, angled approximately 1° to 4° and morespecifically, approximately 2°, as the slots 816, 818, 820, 822 extendbetween the top and bottom surfaces 802, 804. It is also contemplatedthat some of slots 816, 818, 820, 822 may be angled and other slots 816,818, 820, 822 may be linear as they extend through the base portion 814from the top surface 802 to the bottom surface 804.

In addition, the slots 816, 818 may be oriented, for example, relativelyperpendicular to the first side 810 and the second side 812 as the slots816, 818 extend from the first side 810 to the second side 812, as shownin FIGS. 85-88, 91 and 92 . The slots 820, 822 may be, for example,angled as the slots 820, 822 extend between the first side 810 to thesecond side 812. The slots 820, 822 may also be, for example, angledtoward the slots 816, 818, as the slots 820, 822 extend from the firstside 810 to the second side 812. The slots 820, 822 may also bepositioned to extend parallel to the end of the base portion 814 nearthe first end 806 of the cut guide 800. The slots 820, 822 may be, forexample, angled between approximately 8° and 22° as the slots 820, 822extend from the second side 812 to the first side 810 providing for anangulation correction of 8° to 20°. The slots 816, 818, 820, 822 may beconfigured or sized and shaped to receive a saw blade and may have awidth of, for example, approximately 0.58 mm to 0.92 mm. The slots 816,818, 820, 822 may be positioned, for example, to allow for removal ofthe articular cartilage layer at the ends of the two bones. To preventresecting more tissue than absolutely necessary, the slots 816, 818,820, 822 may be positioned, for example, such that the medial portion ofthe slots 816, 818, 820, 822 are aligned with the intersection of thecartilage and bone.

The base portion 814 may also include a hole or dorsal hole 824, asshown in at least FIGS. 85, 86, and 88-91 . The hole 824 is positionedbetween the second slot 818 and the third slot 820 near the second side812 of the base portion 814. The hole 824 may extend, for example, intothe base portion 814 from the top surface 802 of the cut guide 800 andto a point within the extension member 828. As shown in FIGS. 86, 89, 90and 92 , as the hole 824 extends into the extension member 828, the hole824 forms an opening in a proximal-distal direction through theextension member 828. The hole 824 may, for example, extend into the cutguide 800 parallel to the angled portion of the extension member 828, asshown in FIG. 86 . The hole 824 may be sized and shaped or configured,for example, to receive a wire, alignment wire, k-wire, guide wire orthe like to provide information on the position of the cut guide 800 ina joint. For example, a wire inserted into hole 824 should alignapproximately with the long axis of the patient's tibia to provide theproper orientation of the cut guide 800 in the joint, which may be, forexample, approximately 45° from dorsal and 45° from medial in thefrontal plane.

Referring now to FIGS. 86-88 and 92 , the base portion 814 also includesa recessed region 826 positioned on the bottom surface 804. The recessedregion 826 extends from the first side 810 to the second side 812 andinto the base portion 814 from the bottom surface 804 toward the topsurface 802. The recessed region 826 extends to engage the bonecontacting surface 836 of the first arm 830 at the first side 810 of thebase portion 814. The extension member 828 is coupled to the recessedregion 826 of the base portion 814 and extends away from the recessedregion 826 of the base portion 814. In addition, the extension member828 is positioned between the second slot 818 and the third slot 820.The extension member 828 also extends from the second side 812 towardthe first side 810, as shown in FIGS. 86, 89, 90 and 92 . The extensionmember 828 may include a perpendicular portion near the first side 810that extends perpendicularly away from the bottom surface 804. Theperpendicular portion of the extension member 828 may be, for example,angled when the cut guide 800 is inserted into a patient's joint and theangle that the perpendicular portion is positioned at may correspond tothe angle of the first tarso-metatarsal joint medially. The extensionmember 828 may also include an angled portion extending from the secondside 812 to the end or distal end of the extension member 828. Theextension member 828 may be shaped, for example, to fit within the jointspace between two bones, such as, a first metatarsal and cuneiform, aswell as to mate with the articular joints. The angled portion of theextension member 828 may, for example, be oriented laterally and shouldalign with the long axis of the tibia, as well as fit within the jointto rest against the relatively straight surface of the adjacent bone,for example, the second metatarsal. When the angled portion of theextension member 828 is oriented against the second metatarsal, the cutguide 800 will be positioned at a 45° angle in the frontal plane.

As shown in FIGS. 85, 86, 91 and 92 , the first or proximal arm 830 mayextend away from an end of the base portion 814 and may have, forexample, a first portion extending from the base portion 814 to acoupling portion 838 positioned at the first end 806 of the cut guide800. The coupling portion 838 may have a width larger than the width ofthe first portion of the first arm 830. The coupling portion 838 of thefirst arm 830 includes at least one opening 832, 834. In the depictedembodiment, the first arm 830 includes a first opening 832 and a secondopening 834 positioned near the first end 806. The first opening 832 maybe spaced apart from the second opening 834. The openings 832, 834 mayextend from a top surface 802 to a bottom surface 804 of the couplingportion 838 of the cut guide 800. The openings 832, 834 may extendthrough the coupling portion 838 of the first arm 830, for example,parallel to the extension member 828, angled as they extend from the topsurface 802 toward the bottom surface 804, or a combination of paralleland angled. In one embodiment, the first opening 832 may extend, forexample, parallel to the extension member 828 and the second opening 834may be, for example, angled with respect to the extension member 828 topermit the inserted wires, guide wires, k-wires and the like to crossabove the cut guide 800 without intersecting. By positioning theopenings 832, 834 such that inserted wires cross above the openings 832,834 allows for a smaller surgical incision and less interaction orinterference with other instruments during the procedure. The openings832, 834 positioning the wires to cross also allows for the cut guide800 to be, for example, suspended above and/or proximate to the bonesurfaces being cut. The ability to suspend the cut guide 800 above thebone surfaces prevents the cut guide 800 from being titled because ofvarying patient anatomy and this avoids moving the slots 816, 818, 820,822 which would affect the proposed cut angles. Alternative combinationsof orientations of the openings 832, 834 are also contemplated, as wouldbe understood by one of ordinary skill in the art from the abovedescription. The first arm 830 may be shaped to provide a bonecontacting surface 836 that corresponds to the shape of the bone that itwill engage. The first arm 830 may be, for example, curved or arced asit extends between the first side 810 and the second side 812.

As shown in FIGS. 85, 86, 91 and 92 , the second or distal arm 840 mayextend away from an end of the base portion 814 and may have, forexample, a first portion extending from the base portion 814 to acoupling portion 848 positioned at the second end 808 of the cut guide800. The coupling portion 848 may have a width larger than the width ofthe first portion of the second arm 840. The coupling portion 848 of thesecond arm 840 includes at least one opening 842, 844. In the depictedembodiment, the second arm 840 includes a third opening 842 and a fourthopening 844 positioned near the second end 808. The third opening 842may be spaced apart from the fourth opening 844 and extend from a topsurface 802 to a bottom surface 804 of the cut guide 800. The openings842, 844 may extend through the second arm 840, for example, parallel tothe extension member 828, angled as they extend from the top surface 802toward the bottom surface 804, or a combination of parallel and angled.In one embodiment, the third opening 842 may extend, for example,parallel to the extension member 828 and the fourth opening 844 may be,for example, angled with respect to the extension member 828 to permitinserted wires, guide wires, k-wires, and the like to cross above thecut guide 800 without intersecting. By positioning the openings 842, 844such that the inserted wires cross above the openings 842, 844 allowsfor a smaller surgical incision and less interaction or interferencewith other instruments during the procedure. The openings 842, 844 beingpositioned for the wires to cross, also allows for the cut guide 800 tobe, for example, suspended above and/or mated with the bone surfacesbeing cut. Suspending the cut guide 800 above the bone surfaces preventsthe cut guide 800 from being angled because of varying patient anatomywhich results in not having to move the slots 816, 818, 820, 822 whichwould affect the proposed cut angles. In one embodiment, the openings832, 842 may be, for example, positioned such that they are parallel toone another as they extend between the top and bottom surfaces 802, 804.By positioning the openings 832, 842 parallel to each other, the cutguide 800 may be, for example, removed from guide wires inserted throughopenings 832, 842 without removing the guide wires. In addition,parallel openings 832, 842 allow for the relative rotation between thetwo guide wires to be measured or calculated after the bones are cutusing cut guide 800. Further, the openings 832, 842 may be, for example,spaced apart from the extension member 828 a standard or set distance toallow for interchangeability with alternative cut guides 700, 900, 1000,if a different or additional resection is needed. Alternative,combinations of orientations of the openings 842, 844 are alsocontemplated, as would be understood by one of ordinary skill in the artfrom the above description. The second arm 840 may be shaped to providea bone contacting surface 846 that corresponds to the shape of the bonethat it will engage. The second arm 840 may be, for example, curved orarced as it extends between the first side 810 and the second side 812.The second arm 840 may have, for example, a larger length than the firstarm 830.

Another cut guide 850 is shown in FIGS. 93 and 94 . The cut guide 850 isa mirror image of the cut guide 800 in a medial-lateral direction, whichwill not be described again in full detail for brevity purposes. Forexample, the hole 824 is positioned on a left side of the cut guide 800when in an insertion position and the hole 874 is positioned on a rightside of the cut guide 850 when in an insertion position. The cut guide850 may be, for example, for a left foot. The cut guide 850 may includea top surface 852, a bottom surface 854, a first or proximal end 856, asecond or distal end 858, a first or medial side 860, and a second orlateral side 862, which may be of the type described above with respectto the top surface 802, the bottom surface 804, the first or proximalend 806, the second or distal end 808, the first or medial side 810, andthe second or lateral side 812, respectively. The cut guide 850 may alsoinclude a base portion 864 which may be the mirror image of the baseportion 814, as described above. The slots 866, 868, 870, 872, the hole874, and the recessed region 876 may be the same or similar to the slots816, 818, 820, 822, the hole 824, and the recessed region 826, asdescribed in greater detail above. Further, the cut guide 850 mayinclude a fin, paddle or extension member 878, a first or proximal arm880, and a second or distal arm 890, which may be as described abovewith respect to the extension member 828, the first arm 830, and thesecond arm 840, respectively. The coupling portion 888, the openings882, 884 and the bone contacting surface 886 may be as described abovewith reference to the coupling portion 838, the openings 832, 834 andthe bone contacting surface 836 and the coupling portion 898, theopenings 892, 894 and the bone contacting surface 896 may be asdescribed above with reference to the coupling portion 848, the openings842, 844 and the bone contacting surface 846, which will not bedescribed again here for brevity purposes.

Referring now to FIGS. 95-102 , a cut guide 900 is shown. The cut guide900 includes a top surface 902, a bottom surface 904, a first orproximal end 906, a second or distal end 908, a first or medial side910, and a second or lateral side 912. The cut guide 900 also includes abase portion 914, a paddle, fin or extension member 928 extending awayfrom the bottom surface 904 of the base portion 914, a first or proximalarm 930 extending away from the base portion 914 on the first end 906,and a second or distal arm 940 extending away from the base portion 914on the second end 908. The cut guide 900 may be, for example, a rightfoot cut guide.

As shown in FIGS. 95, 99 and 100 , the top surface 902 of the baseportion 914 may be, for example, curved or arced between the first side910 and the second side 912. In one embodiment, the top surface 902 ofthe base portion 914 may include, for example, a flat or planar portionpositioned between a first curvature or arc extending from the firstside 910 to the flat portion and a second curvature or arc extendingfrom a second side 912 to the flat portion. The end of the base portion914 near the first end 906 of the cut guide 900 may extend, for example,perpendicularly between the first side 910 to the second side 912, asshown in FIG. 101 . The end of the base portion 914 near the second end908 of the cut guide 900 may extend, for example, perpendicularlybetween the first side 910 and the second side 912, as shown in FIG. 101.

The base portion 914 also includes at least one slot 916, 918, 920, 922,as shown in FIGS. 89-98, 101 and 102 . In the depicted embodiment, thebase portion 914 includes a first slot 916 adjacent to a second slot 918and a third slot 920 adjacent to a fourth slot 922. The first and secondslots 916, 918 are positioned on the base portion 914 near the secondend 908 of the cut guide 900 and the third and fourth slots 920, 922 arepositioned on the base portion 914 near the first end 906 of the cutguide 900. The slots 916, 918, 920, 922 may extend, for example,linearly or angled through the base portion 914 from the top surface 902to the bottom surface 904 of the cut guide 900. The slots 916, 918, 920,922 may be, for example, angled approximately 1° to 4° and morespecifically, approximately 2°, as the slots 916, 918, 920, 922 extendbetween the top and bottom surfaces 902, 904. It is also contemplatedthat some of slots 916, 918, 920, 922 may be angled and other slots 916,918, 920, 922 may be linear as they extend through the base portion 914from the top surface 902 to the bottom surface 904.

In addition, the slots 916, 918 may be oriented, for example, relativelyperpendicular to the first side 910 and the second side 912 as the slots916, 918 extend from the first side 910 to the second side 912, as shownin FIGS. 95-98, 101 and 102 . The slots 916, 918 may also be positionedto extend parallel to the end of the base portion 914 near the secondend 908 of the cut guide 900. The slots 920, 922 may also be oriented,for example, relatively perpendicular to the first side 910 and thesecond side 912 as the slots 920, 922 extend from the first side 910 tothe second side 912. The slots 920, 922 may also be positioned to extendparallel to the end of the base portion 914 near the first end 906 ofthe cut guide 900. The slots 916, 918, 920, 922 may be, for example,angled approximately 0° to 30° as the slots 916, 918, 920, 922 extendfrom the second side 912 to the first side 910 providing for anangulation correction of 4° to 20°. The slots 916, 918, 920, 922 may beconfigured or sized and shaped to receive a saw blade and may have awidth of, for example, approximately 0.58 mm to 0.92 mm. The slots 916,918, 920, 922 may be positioned, for example, to allow for removal ofthe articular cartilage layer at the ends of the two bones. To preventresecting more tissue than absolutely necessary, the slots 916, 918,920, 922 may be positioned, for example, such that the medial portion ofthe slots 916, 918, 920, 922 are aligned with the intersection of thecartilage and bone.

The base portion 914 may also include a hole or dorsal hole 924, asshown in at least FIGS. 95, 96, and 98-101 . The hole 924 is positionedbetween the second slot 918 and the third slot 920 near the second side912 of the base portion 914. The hole 924 may extend, for example, intothe base portion 914 from the top surface 902 of the cut guide 900 andto a point within the extension member 928. As shown in FIGS. 96, 99,100 and 102 , as the hole 924 extends into the extension member 928, thehole 924 forms an opening in a proximal-distal direction through theextension member 928. The hole 924 may, for example, extend into the cutguide 900 parallel to the angled portion of the extension member 928, asshown in FIG. 96 . The hole 924 may be sized and shaped or configured,for example, to receive a wire, alignment wire, k-wire, guide wire orthe like to provide information on the position of the cut guide 900 ina joint. For example, a wire inserted into hole 924 should alignapproximately with the long axis of the patient's tibia to provide theproper orientation of the cut guide 900 in the joint, which may be, forexample, approximately 45° from dorsal and 45° from medial in thefrontal plane.

Referring now to FIGS. 96-98 and 102 , the base portion 914 alsoincludes a recessed region 926 positioned on the bottom surface 904. Therecessed region 926 extends from the first side 910 to the second side912 and into the base portion 914 from the bottom surface 904 toward thetop surface 902. The recessed region 926 extends to engage the bonecontacting surface 936 of the first arm 930 at the first side 910 of thebase portion 914. The extension member 928 is coupled to the recessedregion 926 of the base portion 914 and extends away from the recessedregion 926 of the base portion 914. In addition, the extension member928 is positioned between the second slot 918 and the third slot 920.The extension member 928 also extends from the second side 912 towardthe first side 910, as shown in FIGS. 96, 99, 100 and 102 . Theextension member 928 may include a perpendicular portion near the firstside 910 that extends perpendicularly away from the bottom surface 904.The perpendicular portion of the extension member 928 may be, forexample, angled when the cut guide 900 is inserted into a patient'sjoint and the angle that the perpendicular portion is positioned at maycorrespond to the angle of the first tarso-metatarsal joint medially.The extension member 928 may also include an angled portion extendingfrom the second side 912 to the end or distal end of the extensionmember 928. The extension member 928 may be shaped, for example, to fitwithin the joint space between two bones, such as, a first metatarsaland cuneiform, as well as to mate with the articular joints. The angledportion of the extension member 928 may, for example, be orientedlaterally and should align with the long axis of the tibia, as well asfit within the joint to rest against the relatively straight surface ofthe adjacent bone, for example, the second metatarsal. When the angledportion of the extension member 928 is oriented against the secondmetatarsal, the cut guide 900 will be positioned at a 45° angle in thefrontal plane.

As shown in FIGS. 95, 96, 101 and 102 , the first or proximal arm 930may extend away from an end of the base portion 914 and may have, forexample, a first portion extending from the base portion 914 to acoupling portion 938 positioned at the first end 906 of the cut guide900. The coupling portion 938 may have a width larger than the width ofthe first portion of the first arm 930. The coupling portion 938 of thefirst arm 930 includes at least one opening 932, 934. In the depictedembodiment, the first arm 930 includes a first opening 932 and a secondopening 934 positioned near the first end 906. The first opening 932 maybe spaced apart from the second opening 934. The openings 932, 934 mayextend from a top surface 902 to a bottom surface 904 of the couplingportion 938 of the cut guide 900. The openings 932, 934 may extendthrough the coupling portion 938 of the first arm 930, for example,parallel to the extension member 928, angled as they extend from the topsurface 902 toward the bottom surface 904, or a combination of paralleland angled. In one embodiment, the first opening 932 may extend, forexample, parallel to the extension member 928 and the second opening 934may be, for example, angled with respect to the extension member 928 topermit the inserted wires, guide wires, k-wires and the like to crossabove the cut guide 900 without intersecting. By positioning theopenings 932, 934 such that inserted wires cross above the openings 932,934 allows for a smaller surgical incision and less interaction orinterference with other instruments during the procedure. The openings932, 934 positioning the wires to cross also allows for the cut guide900 to be, for example, suspended above and/or proximate to the bonesurfaces being cut. The ability to suspend the cut guide 900 above thebone surfaces prevents the cut guide 900 from being titled because ofvarying patient anatomy and this avoids moving the slots 916, 918, 920,922 which would affect the proposed cut angles. Alternative combinationsof orientations of the openings 932, 934 are also contemplated, as wouldbe understood by one of ordinary skill in the art from the abovedescription. The first arm 930 may be shaped to provide a bonecontacting surface 936 that corresponds to the shape of the bone that itwill engage. The first arm 930 may be, for example, curved or arced asit extends between the first side 910 and the second side 912.

As shown in FIGS. 95, 96, 101 and 102 , the second or distal arm 940 mayextend away from an end of the base portion 914 and may have, forexample, a first portion extending from the base portion 914 to acoupling portion 948 positioned at the second end 908 of the cut guide900. The coupling portion 948 may have a width larger than the width ofthe first portion of the second arm 940. The coupling portion 948 of thesecond arm 940 includes at least one opening 942, 944. In the depictedembodiment, the second arm 940 includes a third opening 942 and a fourthopening 944 positioned near the second end 908. The third opening 942may be spaced apart from the fourth opening 944 and extend from a topsurface 902 to a bottom surface 904 of the cut guide 900. The openings942, 944 may extend through the second arm 940, for example, parallel tothe extension member 928, angled as they extend from the top surface 902toward the bottom surface 904, or a combination of parallel and angled.In one embodiment, the third opening 942 may extend, for example,parallel to the extension member 928 and the fourth opening 944 may be,for example, angled with respect to the extension member 928 to permitinserted wires, guide wires, k-wires, and the like to cross above thecut guide 900 without intersecting. By positioning the openings 942, 944such that the inserted wires cross above the openings 942, 944 allowsfor a smaller surgical incision and less interaction or interferencewith other instruments during the procedure. The openings 942, 944 beingpositioned for the wires to cross, also allows for the cut guide 900 tobe, for example, suspended above and/or mated with the bone surfacesbeing cut. Suspending the cut guide 900 above the bone surfaces preventsthe cut guide 900 from being angled because of varying patient anatomywhich results in not having to move the slots 916, 918, 920, 922 whichwould affect the proposed cut angles. In one embodiment, the openings932, 942 may be, for example, positioned such that they are parallel toone another as they extend between the top and bottom surfaces 902, 904.By positioning the openings 932, 942 parallel to each other, the cutguide 900 may be, for example, removed from guide wires inserted throughopenings 932, 942 without removing the guide wires. In addition,parallel openings 932, 942 allow for the relative rotation between thetwo guide wires to be measured or calculated after the bones are cutusing cut guide 900. Further, the openings 932, 942 may be, for example,spaced apart from the extension member 928 a standard or set distance toallow for interchangeability with alternative cut guides 700, 800, 1000,if a different or additional resection is needed. Alternative,combinations of orientations of the openings 942, 944 are alsocontemplated, as would be understood by one of ordinary skill in the artfrom the above description. The second arm 940 may be shaped to providea bone contacting surface 946 that corresponds to the shape of the bonethat it will engage. The second arm 940 may be, for example, curved orarced as it extends between the first side 910 and the second side 912.The second arm 940 may have, for example, a larger length than the firstarm 930.

FIGS. 103 and 104 show another cut guide 950. Another cut guide 950 isshown in FIGS. 103 and 104 . The cut guide 950 is a mirror image of thecut guide 900 in a medial-lateral direction, which will not be describedagain in full detail for brevity purposes. For example, the hole 924 ispositioned on a left side of the cut guide 900 when in an insertionposition and the hole 974 is positioned on a right side of the cut guide950 when in an insertion position. The cut guide 950 may be, forexample, for a left foot. The cut guide 950 may include a top surface952, a bottom surface 954, a first or proximal end 956, a second ordistal end 958, a first or medial side 960, and a second or lateral side962, which may be of the type described above with respect to the topsurface 902, the bottom surface 904, the first or proximal end 906, thesecond or distal end 908, the first or medial side 910, and the secondor lateral side 912, respectively. The cut guide 950 may also include abase portion 964 which may be the mirror image of the base portion 914,as described above. The slots 966, 968, 970, 972, the hole 974, and therecessed region 976 may be the same or similar to the slots 916, 918,920, 922, the hole 924, and the recessed region 926, as described ingreater detail above. Further, the cut guide 950 may include a fin,paddle or extension member 978, a first or proximal arm 980, and asecond or distal arm 990, which may be as described above with respectto the extension member 928, the first arm 930, and the second arm 940,respectively. The coupling portion 988, the openings 982, 984 and thebone contacting surface 986 may be as described above with reference tothe coupling portion 938, the openings 932, 934 and the bone contactingsurface 936 and the coupling portion 998, the openings 992, 994 and thebone contacting surface 996 may be as described above with reference tothe coupling portion 948, the openings 942, 944 and the bone contactingsurface 946, which will not be described again here for brevitypurposes.

Referring now to FIGS. 105-112 , a cut guide 1000 is shown. The cutguide 1000 includes a top surface 1002, a bottom surface 1004, a firstend 1006, a second end 1008, a first side 1010, and a second side 1012.The first end 1006 may be, for example, a proximal end, and the secondend 1008 may be, for example, a distal end, or vice versa. The firstside 1010 may be, for example, a medial side, and the second side 1012may be, for example, a lateral side, or vice versa. The cut guide 1000also includes a base portion 1014, a paddle, fin or extension member1022 extending away from the bottom surface 1004 of the base portion1014, and an arm 1030 extending away from the base portion 1014 on thesecond end 1008. As shown in FIGS. 105-112 , the cut guide 1000 may be,for example, a right foot cut guide. The cut guide 1000 may provide, forexample, a 4° angulation from dorsal to plantar on the metatarsal.

Cut guide 1000 may be used, for example, when a surgeon decides thatcorrection of the first metatarsal in plantarflexion is not sufficientenough and needs to take off more of the metatarsal from the dorsal toplantar direction. Alternatively, cut guide 1000 may be used, forexample, when a surgeon knows from pre-operative radiographs that thefirst ray is dorsiflexed in order to cut more bone of the metatarsalplantarly to correct the dorsiflexion. For example, when guide 1000 isused, it will be inserted into the patient's joint, the surgeon will usecut guide 1000 to cut the first metatarsal, then cut guide 1000 will beremoved and replaced with another cut guide, such as, cut guide 700,800, 900, to cut the cuneiform. The second guide 700, 800, 900 will beselected based on the size and desired angular correction of thecuneiform. The cut guide 1000 may be removed from the patient's bones,for example, by sliding the guide 1000 off a guide wire inserted throughthe opening 1032 and inserting the second cut guide 700, 800, 900 ontothe guide wire to properly align the second cut guide 700, 800, 900 onthe patient's bones with respect to the first cut made to themetatarsal.

As shown in FIGS. 105, 109 and 110 , the top surface 1002 of the baseportion 1014 may be, for example, curved or arced between the first side1010 and the second side 1012. In an embodiment, the top surface 1002 ofthe base portion 1014 may include, for example, a flat or planar portionpositioned between a first curvature or arc extending from the firstside 1010 to the flat portion and a second curvature or arc extendingfrom the second side 1012 to the flat portion. The base portion 1014also includes at least one slot 1016, 1018, as shown in FIGS. 105-108,111 and 112 . In the depicted embodiment, the first slot 1016 ispositioned adjacent to a second slot 1018. The slots 1016, 1018 mayextend, for example, through the base portion 1014 from the top surface1002 to the bottom surface 1004 of the cut guide 1000. The slots 1016,1018 may be, for example, angled as the slots 1016, 1018 extend from thetop surface 1002 to the bottom surface 1004. The slots 1016, 1018 may beangled, for example, approximately 1° to 4° and more specifically,approximately 2°, as the slots 1016, 1018 extend between the top surface1002 and the bottom surface 1004. It is also contemplated that theinterior slot 1016 may be angled while the exterior slot 1018 may belinear as they extend between the top and bottom surfaces 1002, 1004.

In addition, the slots 1016, 1018 may be angled as they extend acrossthe base portion 1014 from the first side 1010 to the second side 1012,as shown in FIGS. 111 and 112 . The slots 1016, 1018 may be, forexample, angled at approximately 6° as they extend between the first andsecond sides 1010, 1012 providing for an angulation correction of 4°.The slots 1016, 1018 may be configured or sized and shaped to receive asaw blade and may have a width of, for example, approximately 0.58 mm to0.92 mm. As shown in FIG. 111 , the slots 1016, 1018 may be angled froma distal-medial position to a proximal-lateral position of the cut guide1000. The slots 1016, 1018 may be positioned, for example, to allow forremoval of the articular cartilage only. To prevent resecting too muchtissue, the slots 1016, 1018 may be positioned, for example, such thatthe medial portion of the slots 1016, 1018 are aligned with thecartilage and bone boundary.

The base portion 1014 also includes a hole or dorsal hole 1020, as shownin at least FIGS. 105-107, 111 and 112 . The hole 1020 is positionedbetween the second slot 1018 and the arm 1030. The hole 1020 may extend,for example, through the base portion 1014 from the top surface 1002 tothe bottom surface 1004. The hole 1020 may, for example, extend throughthe base portion 1014 of the cut guide 1000 parallel to the angledportion of the extension member 1022, as shown in FIG. 105 . The hole1020 may be sized and shaped or configured, for example, to receive awire, alignment wire, k-wire, guide wire, directional wire or the liketo provide information on the position of the cut guide 1000 in a joint.For example, the wire inserted into hole 1020 should align approximatelywith the long axis of the tibia to provide the proper orientation of thecut guide 1000 in the joint, which may be, for example, approximately45° from dorsal and 45° from medial in the frontal plane.

Referring now to FIGS. 106-110 and 112 , the extension member 1022 isattached to a bottom surface 1004 of the base portion 1014. Theextension member 1022 also extends away from the base portion 1014 andis positioned on the first end 1006 of the cut guide 1000. In addition,the extension member 1022 extends from the second side 1012 toward thefirst side 1010, as shown in at least FIGS. 106, 109 and 110 . Theextension member 1022 may include a portion near the first side 1010that extends perpendicularly away from the bottom surface 1004. Theperpendicular portion of the extension member 1022 may be, for example,angled when the cut guide 1000 is inserted into a patient's joint andthe angle that the perpendicular portion is positioned at may correspondto the angle of the first tarso-metatarsal joint medially. The extensionmember 1022 may also include an angled portion extending from the secondside 1012 to the end of the extension member 1022. The extension member1022 may be shaped, for example, to fit within the joint space betweenthe two bones, such as, a first metatarsal and cuneiform, as well as tomate with the two sides of an articular joint. The angled portion of theextension member 1022 may, for example, be oriented laterally and shouldalign with the long axis of the tibia, as well as fit within the jointto rest against the relatively straight surface of the adjacent bone,for example, the second metatarsal. When the angled portion of theextension member 1022 is oriented against the second metatarsal, the cutguide 1000 will be positioned at a 45° angle in the frontal plane.

As shown in FIGS. 105-108 and 110-112 , the arm 1030 may extend awayfrom an end of the base portion 1014 and may have, for example, a firstportion extending from the base portion 1014 to a coupling portion 1038positioned at the first end 1006 of the cut guide 1000. The couplingportion 1038 may have a width larger than the width of the first portionof the arm 1030. The coupling portion 1038 of the arm 1030 includes atleast one opening 1032, 1034. In the depicted embodiment, the arm 1030includes a first opening 1032 and a second opening 1034 positioned nearthe first end 1006. The first opening 1032 may be spaced apart from thesecond opening 1034. The openings 1032, 1034 may extend from a topsurface 1002 to a bottom surface 1004 of the coupling portion 1038 ofthe cut guide 1000. The openings 1032, 1034 may extend through thecoupling portion 1038 of the arm 1030, for example, parallel to theextension member 1028, angled as they extend from the top surface 1002toward the bottom surface 1004, or a combination of parallel and angled.In one embodiment, the first opening 1032 may extend, for example,parallel to the extension member 1028 and the second opening 1034 maybe, for example, angled with respect to the extension member 1028 topermit the inserted wires, guide wires, k-wires and the like to crossabove the cut guide 1000 without intersecting. By positioning theopenings 1032, 1034 such that inserted wires cross above the openings1032, 1034 allows for a smaller surgical incision and less interactionor interference with other instruments during the procedure. Theopenings 1032, 1034 positioning the wires to cross also allows for thecut guide 1000 to be, for example, suspended above and/or proximate tothe bone surfaces being cut. The ability to suspend the cut guide 1000above the bone surfaces prevents the cut guide 1000 from being titledbecause of varying patient anatomy and this avoids moving the slots1016, 1018 which would affect the proposed cut angles. Alternativecombinations of orientations of the openings 1032, 1034 are alsocontemplated, as would be understood by one of ordinary skill in the artfrom the above description. The arm 1030 may be shaped to provide a bonecontacting surface 1036 that corresponds to the shape of the bone thatit will engage. The arm 1030 may be, for example, curved or arced as itextends between the first side 1010 and the second side 1012.

With reference to FIGS. 113 and 114 another cut guide 1050 is shown. Asshown, the cut guide 1050 may be a mirror image of the cut guide 1000 ina medial-lateral direction, therefore, the cut guide 1050 will not bedescribed in full detail for brevity purposes. Therefore, the cut guide1050 may be, for example, for a left foot. The cut guide 1050 mayinclude a top surface 1052, a bottom surface 1054, a first or proximalend 1056, a second or distal end 1058, a first or medial side 1060, anda second or lateral side 1062, which may be as described above withrespect to the top surface 1002, the bottom surface 1004, the first orproximal end 1006, the second or distal end 1008, the first or medialside 1010, and the second or lateral side 1012, respectively, which willnot be described again here for brevity sake. As the cut guide 1050 is amirror image of the cut guide 1000, the cut guide 1050 may also includea base portion 1064 which may be the mirror image of the base portion1014 as described above. In addition, the hole 1020 is positioned on aleft side of the cut guide 1000 when in an insertion position and thehole 1070 is positioned on the right side of the cut guide 1050 when inan insertion position. The slots 1066, 1068 and the hole 1070 may besimilar to the slots 1016, 1018 and hole 1020, as described in greaterdetail above. Specifically, as the cut guide 1050 is a mirror image ofthe cut guide 1000, the slots 1066, 1068 may be angled from adistal-lateral position to a proximal-medial position of the cut guide1050 resulting in 4° of cumulative dorsal to plantar cutting, asdescribed in greater detail above with reference to cut guide 1000.Further, the cut guide 1050 may include a fin, paddle or extensionmember 1072 and an arm 1080, which may be as described above withrespect to the fin, paddle or extension member 1022 and the arm 1030,respectively. The openings 1082, 1084 and bone contacting surface 1086may be as described above with reference to the openings 1032, 1034 andbone contacting surface 1036, which will not be described again here forbrevity purposes.

As may be recognized by those of ordinary skill in the art based on theteachings herein, numerous changes and modifications may be made to theabove-described and other embodiments of the present disclosure withoutdeparting from the scope of the disclosure. The components of the guidesand/or systems as disclosed in the specification, including theaccompanying abstract and drawings, may be replaced by alternativecomponent(s) or feature(s), such as those disclosed in anotherembodiment, which serve the same, equivalent or similar purpose as knownby those skilled in the art to achieve the same, equivalent or similarresults by such alternative component(s) or feature(s) to provide asimilar function for the intended purpose. In addition, the guides andsystems may include more or fewer components or features than theembodiments as described and illustrated herein. For example, thecomponents and features of FIGS. 1-8 , FIGS. 9-10 , FIGS. 11-18 , FIGS.19-26 , FIGS. 27-34 , FIGS. 35-36 , and FIGS. 37-44 , FIGS. 66-74 ,FIGS. 75-82 , FIGS. 83-84 , FIGS. 85-92 , FIGS. 93-94 , FIGS. 95-102 ,FIGS. 103-104 , FIGS. 105-112 and FIGS. 113-114 may be usedinterchangeably and in alternative combinations as would be modified oraltered by one of skill in the art. Accordingly, this detaileddescription of the currently-preferred embodiments is to be taken in anillustrative, as opposed to limiting of the disclosure.

The terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the disclosure.As used herein, the singular forms “a”, “an” and “the” are intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. It will be further understood that the terms “comprise” (andany form of comprise, such as “comprises” and “comprising”), “have” (andany form of have, such as “has”, and “having”), “include” (and any formof include, such as “includes” and “including”), and “contain” (and anyform of contain, such as “contains” and “containing”) are open-endedlinking verbs. As a result, a method or device that “comprises,” “has,”“includes,” or “contains” one or more steps or elements possesses thoseone or more steps or elements, but is not limited to possessing onlythose one or more steps or elements. Likewise, a step of a method or anelement of a device that “comprises,” “has,” “includes,” or “contains”one or more features possesses those one or more features, but is notlimited to possessing only those one or more features. Furthermore, adevice or structure that is configured in a certain way is configured inat least that way, but may also be configured in ways that are notlisted.

The disclosure has been described with reference to the preferredembodiments. It will be understood that the architectural andoperational embodiments described herein are exemplary of a plurality ofpossible arrangements to provide the same general features,characteristics, and general system operation. Modifications andalterations will occur to others upon a reading and understanding of thepreceding detailed description. It is intended that the disclosure beconstrued as including all such modifications and alterations.

Having thus described the preferred embodiments, the invention is nowclaimed to be:
 1. A guide system, comprising: a cut guide, wherein thecut guide comprises: a base portion, wherein the base portion furthercomprises: a hole extending into the base portion from a top surface; anextension member extending away from a bottom surface of the baseportion, wherein the hole extends into the extension member; and atleast one arm extending away from an end of the base portion; and analignment guide configured to releasably engage with the cut guide. 2.The guide system of claim 1, wherein the base portion of the cut guidecomprises at least one slot positioned on or between a first end of thebase portion and a second end of the base portion and extending betweena first side of the base portion and a second side of the base portion.3. The guide system of claim 2, wherein the alignment guide isconfigured to removably engage with the at least one slot such that thealignment guide is releasably coupled with the cut guide.
 4. The guidesystem of claim 2, wherein the at least one slot is two slots.
 5. Theguide system of claim 2, wherein the at least one slot is four slots. 6.The guide system of claim 2, wherein the at least one slot is angled asit extends from the second side to the first side of the base portion.7. The guide system of claim 2, wherein the at least one slot is angledas it extends from a top surface through the bottom surface of the baseportion.
 8. The guide system of claim 1, wherein the at least one armcomprises: a first arm extending away from a first end of the baseportion; and a second arm extending away from a second end of the baseportion.
 9. The guide system of claim 8, wherein the first armcomprises: a first tapered body with a first end coupled to the firstend of the base portion and a second end; a first opening positionednear the second end of the first tapered body; and a second openingpositioned near the second end of the first tapered body and spacedapart from the first opening.
 10. The guide system of claim 9, whereinthe first opening extends through the first arm from a top surfacethrough a bottom surface of the first arm and the first opening extendsparallel to the extension member; and wherein the second opening extendsthrough the first arm from the top surface through the bottom surfaceand the second opening is angled relative to the extension member. 11.The guide system of claim 8, wherein the second arm comprises: a secondtapered body with a first end coupled to the second end of the baseportion and a second end; a third opening positioned near the second endof the second tapered body; and a fourth opening positioned near thesecond end of the second tapered body and spaced apart from the firstopening.
 12. The guide system of claim 11, wherein the third openingextends through the second arm from a top surface through a bottomsurface of the second arm and the second opening extends parallel to theextension member; and wherein the fourth opening extends through thesecond arm from the top surface through the bottom surface and thefourth opening is angled relative to the extension member.
 13. The guidesystem of claim 1, wherein the base portion further comprises: arecessed region extending into the base portion from the bottom surfacetoward a top surface of the base portion.
 14. The guide system of claim1, further comprising: a position rotation device.
 15. A cut guide,comprising: a base portion comprising: at least one slot disposedbetween a first end and a second end of the base portion and extendingbetween a first side and a second side of the base portion, wherein theat least one slot is angled as it extends from a top surface through toa bottom surface of the base portion; and a hole extending into the baseportion from the top surface; an extension member extending away fromthe bottom surface of the base portion, wherein the hole extends intothe extension member; at least one arm extending away from an end of thebase portion; and a recessed region extending into the base portion fromthe bottom surface and toward the top surface of the base portion. 16.The cut guide of claim 15, wherein the at least one arm furthercomprises: a first arm extending away from a first end of the baseportion, comprising: a first tapered body with a first end coupled tothe first end of the base portion and a second end opposite the firstend; a first opening positioned near the second end of the first taperedbody; and a second opening positioned near the second end of the firsttapered body and spaced apart from the first opening; a second armextending away from a second end of the base portion, comprising: asecond tapered body with a first end coupled to the second end of thebase portion and a second end; a third opening positioned near thesecond end of the second tapered body; and a fourth opening positionednear the second end of the second tapered body and spaced apart from thefirst opening.
 17. A cut guide, comprising: a base portion, wherein thebase portion further comprises: a hole extending into the base portionfrom a top surface; an extension member extending away from a bottomsurface of the base portion; wherein the hole extends into the extensionmember; at least one arm extending away from a bottom surface of thebase portion; and at least one slot disposed on the base portionconfigured to removably engage with an alignment guide.